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BIOCOMPATIBILITY OF

DENTAL MATERIALS
Dr. Marisha Dahal

FLOW CHART

INTRODUCTION

DEFINITION

HISTORICAL BACKGROUND

LOCAL AND SYSTEMIC EFFECTS

KEY PRINCIPLES THAT DETERMINE


ADVERSE EFFECTS FROM MATERIALS

MEASURING THE BIOCOMPATIBILITY

OF MATERIALS.
A.DEFINING THE USE OF MATERIAL.
B.TYPES OF TESTS

C.HOW TESTS ARE USED TOGETHER

10. CURRENT BIOCOMPATIBILITY

ISSUES IN DENTISTRY
A. LATEX
B.NICKEL
C. MERCURY AND AMALGAM

SUMMARY
CONCLUSION

INTRODUCTION
The biocompatibility of dental materials is

a complex topic that draws on knowledge


from biology, patient risk factors ,clinical
experience and engineering.
Although ignored for many years,
biocompatibility is now recognized as a
fundamental requirement for any dental
restorative material.

DEFINITION
biocompatibility is defined as an interaction between
the body and the material. Placement of a material in
the body relates an interface that is normally not
present.
the ability of a material to elicit an appropriate
biological response in a specific application
Williams DF 1987

Biocompatibility depends on the condition

of the host, the properties of the material


and the context in which the material is
used.

Biocompatibility Interactions
Wataha JC 2001 J Prosth Dent;86:203-9

Patient
Material

Material
Function

BIOCOMPATIBILITY

Biological requirements of
dental materials
Be nontoxic to the body
Be nonirritant to oral or other tissue
Not produce allergic reaction
Not be mutagenic or carcinogenic

Classification of materials from


biological prospectives

Which contact the soft tissue within the mouth


Which could affect the health of the dental pulp
Those which are used as root canal filling
material
Which affect the hard tissue of the teeth
Used in dental laboratory though not used in
mouth, are handled and may be accidentally

ingested or inhaled

Examples of hazards from


chemicals in DM

Acidic cement may cause pulp irritation


Mercury in amalgam whose vapour is toxic
Dust from alginate may be inhaled, some contain
lead compounds
Monomer in denture based materials is a potential
irritant
Some people are allergic to alloys containg Nickel
Eugenol in impression paste can cause irritation
and burning in some patient

Microlekage
Can result into :
1. Secondary caries
2. Stain or discoloration
3. Sensitivity

HISTORICAL BACKGROUND
The concept of ethical treatment of

patients dates back to the time of


Hippocrates(460-370)

As late as mid 1800s dentists tried new

materials for the first time by putting them


into patients mouth

G.V.Black

used patients to test many of


his new ideas for restorative materials
,such as early amalgams.

The concept of protecting the patients as

research is only 30 to 40 years old.


The current philosophy about testing

biological properties of dental materials in


a systematic way evolved in the 1960s

ADVERSE EFFECTS FROM


DENTAL MATERIALS

The biological reactions to materials have


been separated into toxic ,inflammatory
,allergic and mutagenic reactions.

Materials may be capable of releasing

substances into patients body and the


release of certain substances in adequate
amounts can cause overt toxicity.

For example early dental materials containing lead


posed a real risk to the patient because of the toxic
properties of the lead that leached into the patients
body.

Inflammation

is second fundamental type of


biological response to a material.

The inflammatory response is complex but

involves the activation of the hosts immune


system to ward off some threat.

Inflammation may result also form toxicity or


form allergy, and often the inflammatory
response proceeds toxicity.

Current biocompatibility research attempts

to determine whether materials may cause


or contribute to inflammation in the host
even if no toxicity is evident.

An allergic reaction occurs when the body

specifically recognizes a materials, as


foreign and reacts disproportionately to
the amount of the material present.

A key difference between a non-allergic


inflammatory response and an allergic response
is the fact that in an allergic response, the
individuals immune system recognizes a
substance as foreign.

Thus not all individuals will react to that


substance.

Mutagenic

reactions result when the


components of a material alter the base pair
sequences of the DNA in cells.

These alterations are termed mutations.

Mutations may be caused by direct

interactions between a substance and


DNA or indirectly by alterations in cellular
processes that maintain DNA integrity.

LOCAL AND SYSTEMIC


EFFECTS OF MATERIALS

Any material used in the body may have

local or systemic biological effects.


These effects are modulated primarily by

substances that are released from the


material and the biological responses to
those substances.

Systemic effects from dental materials are also a


function of the distribution of substances
released form materials.

These substances might gain access to the


body via ingestion and absorption in the gut,
inhaled vapor ,release at the tooth apex, or
absorption through the oral mucosa.

Their distribution may occur by simple

diffusion ingestions and absorption


through the oral mucosa.
Their distribution may occur by simple

diffusion or transport via the lymphatic or


blood vessels.

The systemic biological response depends

on

The duration and concentration of


the exposure
The excretion rate of the substance
The site of the exposure

Furthermore not all tissues react equally.

systemic reactions may also be influenced


by organs such as the liver that alter
substances in an attempt to digest or
excrete them.

TYPES OF TESTS
ADVANTAGS AND DISADVANTAGES

There are three basic types of tests used to


measure the biocompatibility of dental materials,

the in vitro test,


2. the animal test,
3. the usage test
(performed either in animals or in humans)
1.

IN VITRO TESTS
Are performed outside of an organism.
Historically in vitro tests have be ensued
as the first screening test to evaluate a
new material.
These tests may be conducted in a test
tube, cell culture dish, flask,or other
container but they are performed
separately form an intact organism .
In any case the material or an extract of a
material is placed into contact with some
biological system.

The biological system

may consist of
mammalian cells cellular organelles,
tissue bacteria or some sort of enzyme.

The contact between the biological system

and the material may be direct or indirect.

DIRECT CONTACT involves

the
exposure of a material or an exact form
material directly with the biological system,
whereas INDIRECT CONTACT occurs
through a barrier of some sort, such as a
agar ,a membrane filter, or dentin.

In vitro tests have several advantages

over animal or usage tests.


They are relatively fast, inexpensive and
easily standardized.
Animal tests place a material into an intact
organism of some type .
Common animals for this type of test are
mice,rats,hamsters, ferrests or guinea
pigs but many other types of animals have
been used, including sheep, monkeys
baboons, pigs cats and dogs..

In ANIMAL

TESTS, an intact animal is


used rather than cells or tissues form an
animal.

Animal test are distinct from

usage tests in
that animal tests expose the animal to the
material without regard to the materials
final use.

Animal tests may also be subdivided into

several types, including short term or long


term systemic toxicity, exposure to intact
or abraded membranes and immune
sensitization or bone response.
There are also animal tests for
mutagenecity, carcinogenecity and other
specialized conditions.

Regardless of the type of test used, the

advantage of an animal test is its ability to


allow an intact biological system to
respond to a material.
The material may interact with the many
complex biological systems within the
animal and a more complete biological
response is therefore measured.

However animal test are expensive and


difficult to control, and they may take many
months even years to complete,
depending on the species caused.
These tests are also controversial because
of ethical concerns about proper animal
treatment.
Furthermore the relevance of an animal
test is often questioned because of
concerns about the ability of any animal
species used to adequately represent the
human species

Despite their disadvantages animal tests

provide an important bridge between the


in vitro environment and the clinical use of
the material, and these tests are likely to
be used in some capacity for the
foreseeable future.

USAGE TESTS

are performed in animals of

humans.
A usage test requires that the material be
placed in an a environment clinically relevant
to the use of the material in clinical practice.
If the test is performed in human, it is
called a clinical trial rather than a usage
test.
The choice of animals for a usage test will
be more limited than for an animal test
because a not all species can be used for all
clinical situations often because of the size
of anatomy of a give species.

Thus usage tests more likely to be performed


on larger animals with anatomy that more
closely resembles that of humans.
The relevance of usage test to clinical practice
potentially high by definition.
However the ultimate relevance of a usage
test depends directly on the quality with
which the test mimics the clinical use of the
material in terms of time, area, clinical
environment and placement technique.
The human clinical trial is therefore the gold
standard of usage tests and is the standard by
which in vitro and animal tests are judged.

Usage tests a also have a number of disadvantages.


These tests are extremely complex and difficult to
perform in terms of experimental control and
interpretation.
The tests are exceptionally expensive ,thousands of
dollars may be needed for a single subject.
If humans are to be used, approval of or clinical trial
must be obtained, by law, from an institutional review
board.
The time required for these tests may stretch from
months to years if data on the long term performance of
a mterial are desired.
Finally, human usage tests may involve many legal
liabilities and issues that are not factors for animal and in
vitro tests.

CURRENT BIOCOMPATIBILITY
ISSUES IN DENTISTRY

LATEX

Reactions to latex may vary form localized


rashes and swelling to more serious wheezing
and anaphylaxis.
Dermatitis of hands is the most common
adverse reaction.
A history of eczema and a familial history of
allergies are predisposing factors, and repeated
exposure and duration of exposure play a role in
the degree of response.
The most serious systemic allergic reactions
occur when latex containing products, such as
gloves and rubber dams, contact the mucous
membranes,.

Such exposures may result in

angioneurotic edema, chest pain, and a


rash on the neck and chest of severely
allergic persons.
Asthmatic reactions and other respiratory
reactions have also been reported to
components of the latex that are released
into the air and carried by the powder
coating on many latex products.

NICKEL

Nickel is a common component of many dental


alloys including those used for crown, fixed
dentures, removable partial dentures and some
orthodontic appliances .
Nickel is also used in many types of endodontic
files, although the duration of exposure through
this route is faster and shorter
Nickel is the most allergenic metal known, with
an incidence of some where between 0% to
20%,depending on the study .

MERCURY AND AMALGAM

The controversy over the biocompatibility of


amalgam has waxed and waned several times in
the 170 plus year history of its dental use in the
United States.
Most of the controversy stems form the known
toxicity of mercury and the debate over whether
mercury form amalgams has toxic effects.
Mercury occurs in three forms. As the metal or
in a one of several organic forms, such as
methyl or methyl mercury.

Metallic mercury gains access to the body via


the skin or as a vapor through the lungs.
Ingested metallic mercury is poorly absorbed
form the gut (0.001%) ,so the primary portal into
the body is inhalation of mercury vapor.
Numerous studies have shown that amalgams
release sufficient vapor to cause between 1 and
3 g of mercury absorption per day, depending
on the number of amalgams present.
The inhaled mercury gains access to the blood
stream via the alveoli of the lungs.
Form the blood, mercury is distributed in the
body.

Methyl mercury is the most toxic form of

mercury and is also very efficiently absorbed


form the gut (90% to 95%).
the primary source of methyl mercury is in
the diet, with fish contributing a significant
portion.
Concerns about mercury stem from its
toxicity and it s relatively long half life in the
body. The toxicity of mercury is well known
and the symptoms depend some what on
the form.

No effects of mercury have been noted.


Other studies for neurological symptoms

in various populations occupationally


exposed have shown no effects.
In summary there are simply no data to
show that mercury released form dental
amalgams is harmful.

References
Philips science of dental materials
Basic dental materials, John J Manappallil.