Beruflich Dokumente
Kultur Dokumente
Topics Covered
Background Metallic Fillings Silver Amalgams Alternatives to Silver Amalgams Resin-Based Composite Fillings Disadvantages of Resin-Based Composite Fillings Enhancing the Bond between Resins and Teeth Ion-Leachable Glass Cements Cast Metal Restorations Bonded Restorations Dental Ceramics Overcoming the Brittle Nature of Ceramics Glass Ceramics Dental Implants
Background
Modern dental practice has become very dependent on its materials, such that the dentist's greatest challenge is choosing the right combinations of them for the benefit of their patients.
mercury (mp -39C) it produces a paste of slowly forming intermetallic compounds. When this is packed into the cavity at body temperature (37C), the intermetallic compounds interlock and the amalgam hardens. However, setting is accompanied by a considerable expansion, and 100 years ago it was discovered that this can be controlled by adding tin to the silver. Unfortunately, this produces corrodible tin-mercury intermetallic phases, and their loss can cause breakdown of the filling. By adding copper, the tin-mercury phase is eliminated and modern dental amalgams are made by mixing silver-tin-copper alloy powder with mercury. This results in fillings that resist both the mechanical and chemical onslaughts within the mouth for many years. Although the amount of mercury lost from such fillings is like the contamination of a drink by a drowning midge, those determined to deny the benefits of having usefully restored teeth have over emphasised the risk, and this has generated a search for an alternative, metallic, mercuryfree, filling material.
between the composite and the tooth. Incremental packing and curing helps, but the dentist uses other techniques and other materials to help form a seal.
Resin
Metal
Hydrophobic
Hydrophilic
were used by dentists for half a century to fill cavities in front teeth, for not only did they match the colour and translucency of enamel and dentine, but they also acted as a source of fluoride. It was unusual to see dental decay recurring in any tooth they were used to fill. Similar cements also form when variations on this type of glass are exposed to polymeric acids which possess carboxylate groups. The acids displace metallic ions from the glasses and these cross-link the polymeric acid chains causing the cement to set. The acids also undergo ion exchange reactions with the apatite (calcium phosphate) crystals, which form part of both dentine and dental enamel. These glass ionomer cements, as they are known, thus form direct chemical bonds to teeth, without the need for the primers described above. However, the basic cements lack the strength and resistance to wear that the dental composites have, and recent research has come up with resin-modified versions. These possess not only the carboxylate groups needed to form bonds to teeth, but also the light-curable dimethacrylate components present in the composite resins. Their durability is thus considerably enhanced.
Bonded Restorations
Since the 1960s, alloy-porcelain combinations, known to the dentist as bonded restorations have been available. These porcelain-covered metal castings combine the strength of a metallic superstructure with the aesthetic appearance of dental porcelain, creating the illusion that the restorations are real teeth. Alloys have been developed to which dental porcelains form durable retentive bonds, and many of these are now based on nickel-chromium. These metal frameworks are so rigid that they can be bonded via composites to the backs of acid etched teeth, thus eliminating the need for cutting down sound teeth, figure 1. Just as etching dental enamel creates retentive chasms, these nickel-chromium alloys can be electrolytically etched to produce features that allow the formation of mechanical bonds with resin-based composite cements.
Figure 1. Internal view of a dental bridge bonded via a resin-based cement to the backs of acidetched teeth. The oxides that form on these alloys can also be used to promote chemical links to cements via bifunctional primers, thus eliminating the challenge of producing a uniformly etched surface.
Dental Ceramics
Ceramic materials have the ability to emulate natural teeth, and they are some of the oldest dental materials, going back to 1792, when complete dentures were made from them. In 1996 they are used to create inlays, veneers, and crowns, as facings on metal substrates, and even as bridges, which can be made completely from high-strength ceramics. Restorations in ceramics are generally made by building up the correct aesthetic combinations of prefired, pigmented particles, and then re-firing under vacuum to sinter them together and eliminate voids.
glass-ceramics have also appeared, and these are given post-casting heat treatments that produce reinforcing mica-like crystals within the glass. To bond brittle porcelain to a strong and rigid metal substrate, special porcelaind have been developed with thermal expansion characteristics that match those of the metal. This in turn prevents high interfacial stresses being created between the two as they cool.
Glass Ceramics
Glass ceramics are also used in several CAD/CAM applications in dentistry. In one of these a restoration is designed on a video image of a prepared tooth. It is then machined from a pre-fired block of glass ceramic. All of this takes place in front of the patient. As with all types of ceramic restoration, the machined unit is then coated with a silane bonding agent and cemented to the tooth with a resin-based cement. The tooth itself is also coated with an enamel/dentine bonding agent.
Dental Implants
For years people have been under the impression that the dentist was able to screw in teeth to replace those which were missing. However, what they had experienced was the use of one type of metal post. Posts can be either cemented or screwed into the canals of teeth that have lost their crowns but still have their roots. Such teeth are root-treated to remove their nerves and blood supplies, and onto the posts ceramic or ceramic metal crowns are themselves cemented. Although many attempts have been made to replace missing roots with all sorts on metallic implants, the satisfactory use of a screwed in implant goes back only to the mid 1980s. In practice the gum is slit, and a hole is cut slowly in the bone and then tapped under a continuous flow of sterile, cold water to prevent it being damaged by over-heating. A cold-worked Grade 4 commercially pure titanium screw is then inserted slowly and covered with gum tissue for 6 months. During this time the bone grows into intimate contact with the passive oxide layer on the titanium and it is said to be osseointegrated. The gum tissue is cut once more and a titanium sleeve is screwed onto the implant. This will ultimately pass through the healed gum. Onto these sleeves a metallic superstructure can be screwed and this can support, for example, a polymeric denture base and artificial teeth, figure 2.
Figure 2. Side view of a superplastically-formed, titanium alloy, cantilevered superstructure, attached to dental plaster analogues in a plaster model of a patients jaw. For many years these superstructures have been cast in gold alloys and getting them to sit perfectly on the titanium sleeves has been a challenge of the highest order. However, titanium frameworks are currently being investigated, particularly those constructed by alternative routes to casting, and considerable promise is being shown by those made by superplastic forming. This is undertaken in an inert atmosphere at 900C on reinforced refractory models. Ceramics have also been tried as dental implants. However, because of their brittleness and the smallness of the structures, their optimal role has been as coatings on metal implants. Titanium implants, for example, have had their surfaces coated with hydroxyapatite to try and help osseointegration, and surface active glasses (bioglasses) have been used for the same purpose. Also, by placing them in the holes left behind after the extraction of teeth, these glasses have shown promise in preventing bone resorption.