By

Dr. M. Pavan Preetham

PG (Prosthodontics)
 Contents
Biocompatibility
 Introduction
 Definition
 Requirements of dental materials
 Allergic responses to dental materials
 Minimizing dental iatrogenesis
 Standards that regulate the measurement of biocompatibility
 Biocompatibility of dental materials
 Contents
Mechanical Properties
 Introduction
 Properties measuring elastic deformation
 Properties measuring plastic deformation
 Strength properties and types
 Stress concentration factors
 Other properties
 References
INTRODUCTION
 Biocompatibility-DEFINITION

‘It is the ability of a material to elicit an appropriate

biological response in a specific application’
-William D,F 1987

The term biocompatible is defined as being

harmonious with life & not having toxic or injurious
effects on biologic function
-Dorland’s illustrated Medical Dictionary
Requirements of dental materials
 Shouldn’t be harmful to the pulp and soft tissues.

 Shouldn’t contain toxic diffusible substances.

 Should be free of potentially sensitizing agent.

 Should have no carcinogenic potential

Allergic responses to
dental materials
a) ALLERGIC CONTACT DERMATITIS-
 Most common
 Interval between exposure & clinical manifestations
varies between 12 & 48 hrs.
 Primary irritant dermatitis
 Highest incidence in personnel & patients involved in
orthodontics & pediatric dentistry.
b) ALLERGY TO LATEX PRODUCTS-

 Rubber has been identified as a cause of contact

sensitivity since mid 1940s,Malten & Associates
reported an increasing incidence in 1976.
 It may represent a true latex allergy or a reaction to
accelerators & antioxidants used in latex processing
-Rankin et al 1993
 Thiuram a rubber accelerator also causes allergic
reactions.
 March suggested that the polyether components in latex
rubber gloves was the causative agent.

 FDI(1991) estimated that about 6% to 7% of surgical

personnel may be allergic to latex.

 Dermatitis of the hands (eczema) is the most common

adverse reaction
- Rankin et al,1993
c) ALLERGIC CONTACT STOMATITIS-
Most common adverse reaction to dental materials.
May be local or contact type lesions.
Mercury
The cause of MINIMATA Disaster of early 1970s in
Japan
Symptoms of chronic Hg poisoning:
Nausea
bronchitis
Acronydia (Pink's disease)
Symptoms of elemental Hg poisoning:
swollen and bleeding gums
metallic taste
breathing difficulty
permanent brain damage
Lowest level of total blood Hg at which earliest non specific
symptoms occur is 35ng/ml.

 Allergy to Nickel seen in about 10% of the females &

only 1% male.

Only about 30% of the patients having nickel allergy

develop a reaction to an intra oral nickel chromium dental
alloy.
 Toxicity & allergenicity of beryillium- Berylliosis
 Incorporation of beryllium into the base metal alloy
formulation facilitates castability
 Beryllium containing alloys should be ground with
adequate ventilation.
 Permissible Exposure Limits (PELs) for beryllium allow
exposure to 2 micrograms per cubic meter of air (2 µg/m3)
 In cases where beryllium-containing dental prostheses are
ground or polished in the dental office, precautions should
be considered to minimize any exposure to beryllium-
containing dust.
Minimizing Dental Iatrogenesis
Iatros -physician & genesis - to produce

It is defined as the creation of side effects, problems or

complications resulting from treatment by a physician or
dentist.
STANDARDS THAT REGULATE THE
MEASUREMENT OF BIOCOMPATIBILITY

1. ANSI/ADA Document 41- Initial

Secondary
Usage tests
2. Iso 10993-The final document ISO 10993 was published
in 1992 .

ISO 10993 contains 12 parts.

Initial tests are for cytotoxicity, sensitization & systemic

toxicity
Supplementary tests are- Chronic toxicity
Carcinogenecity
Biodegradation
BIOCOMPATIBILITY OF DENTAL
MATERIALS
REACTIONS OF PULP-
Microleakage: If a bond doesn’t form between the tooth and
the restorative material or debonding occurs, bacteria,
food debris or saliva may be drawn into the gap by
capillary action. this effect has been termed microleakage.
Nanoleakage:
It refers to the leakage of saliva, bacteria or material
components through the interface between a material & a
tooth structure.

It can occur even when the bond between the material &
dentin is intact.
DENTIN BONDING-
Smear layer
Numerous studies have shown removal of the smear layer
improves the strength of the bond between dentin &
restorative materials.

Removal of smear layer poses threat to pulpal tissues

DENTIN BONDING AGENTS-
 HEMA is atleast 100 times less cytotoxic in tissue culture
than BIS-GMA.

 If the dentin is <0.1mm, HEMA may be cytotoxic in vivo

 HEMA and other resins may act synergistically to cause

cytotoxic effects.
RESIN BASED MATERIALS-
Light cured resins are less cytotoxic than chemically
cured systems.
Pulpal response is low to moderate after 3 days when
RDT is 0.5mm.
With a protective liner or bonding agent reaction of the
pulp is minimal.
AMALGAM & CASTING ALLOYS-
Biocompatibility of amalgam is determined largely by
corrosion products released.

With the addition of copper ,amalgams become toxic to cells in

culture.

Implantation tests show that low copper amalgams are well

tolerated,but high copper cause severe reactions.
Gallium alloys are no more toxic than high copper alloys in
cell culture.

Cast alloys contain several noble & non noble metals but the
pulp is more likely to be affected by the luting cement.
GLASS IONOMERS-
In screening tests, freshly prepared ionomer is mildly
toxic, reduces with time.
Fluoride release may cause cytotoxicity.
Histological studies show any inflammatory infiltrate is
minimal or absent after 1 month.
There have been several reports of pulpal hyperalgesia for
short periods .
LINERS,VARNISHES & NON-RESIN
CEMENTS-
CALCIUM HYDROXIDE-

 High pH in suspension leads to extreme cytotoxicity in

screening tests.

 Calcium hydroxide containing resins causes mild to moderate

cytotoxic effects in both freshly set & long term set conditions.

 Inhibition of cell metabolism is reversible.

 Coagulates any hemorrhagic exudate of the superficial pulp

 Initial response of exposed pulpal tissue is necrosis to a
depth of 1 mm or more

 Resins in Ca(OH)2 stimulate reparative dentin formation

more quickly & with no zone of necrosis.

 Resin containing Ca (OH)2 pulp capping agents are the

most effective liners now available for treating pulp
exposures.
ZINC PHOSPHATE-
Strong to moderate cytotoxic reaction that decrease with
time.
Focal necrosis
Placement of a protective layer indicated.
ZINC POLYCARBOXYLATE-
Cytotoxicity correlated with the release of zinc &
fluorides into the culture medium & low pH.
Concentration of polyacrylic acid above 1% cytotoxic.
Reparative dentin formation is minimal ,recommended
only in cavities with intact dentin in the floor.
ZINC OXIDE EUGENOL-

• In vitro,eugenol depresses cell respiration & reduces nerve

transmission with direct contact.

• Effects of eugenol are dose dependent.

• Causes only a slight to moderate inflammatory reaction

BLEACHING AGENTS-
In vitro studies, show peroxides rapidly traverse the
dentin to be cytotoxic.

Cytotoxicity depends on concentration of peroxides.

Tooth sensitivity
Reaction of other oral soft tissues to
restorative materials
Components from dental materials & plaque may
synergize to enhance inflammatory reactions.

Composites are initially very cytotoxic in vitro tests of

direct contact with fibroblasts
Newer composites with non-BISGMA, non-UDMA have
lower cytotoxicity

Polished composites show less cytotoxicity

Methacrylate based composites may cause

hypersensitivity.
Amalgam

• Gingival inflammation
• Copper – bactericidal
• Severe reactions to gallium based alloys- Galloys
• Galloy restorations were associated with a much greater
severity of post-operative sensitivity than Dispersalloy
restorations.

• Patients with palladium allergy are always allergic to

nickel.
Denture base materials-
 Immune hypersensitivity of gingiva & mucosa.
 Residual monomer is inevitable for all PMMA-based
products
 Extended time at high temperature can allow low values
to be attained
 Cold cure have less strength sometimes there is residual
monomer because there is no heat to evaporate residual
monomers
 Auto-polymerizing acrylic denture base resins showed
higher cytotoxicity than heat-polymerizing acrylic denture
base resins - Cytotoxicity Of Denture Base Resins-
Kim SK, Chang IT, Heo SJ, Keak JY.
Denture liners & adhesives-

 Release of plasticizers
 Extremely cytotoxic
 Reaction of soft tissues to
Impression materials
The proliferation of gingival fibroblasts in vitro is highly
reduced by the presence of polyethers

And not by the presence of vinyl polysiloxanes.

 The catalyst of all materials proved to be cytotoxic.

 Aquasil shows peculiar toxicological features in

comparison to other vinyl polysiloxanes.
The cytotoxicity of Elite Implant impression material was
studied directly on gingival fibroblasts proliferation for 48
hours.

Elite Implant is biocompatible.

The manufacturing process and the components, added to

the material in order to make it sterile and radiopaque, do
not make it cytotoxic to human gingival fibroblasts
Injection of Elite Implant light around transfer coping
directly in contact with surgical wound
REACTION OF BONE & SOFT TISSUES
TO IMPLANT MATERIALS
Four basic implant materials: Ceramics
Carbon
Metals & polymers
Reactions to ceramic implant materials-
 Very low toxic effect

Biologic response of carbon coatings can be favorable, they

have been supplanted by titanium, aluminum oxide&
hydroxyapatite
Reactions to pure metals & alloys-

 Oldest type

 Most common-Titanium

 Ti6Al4V has been used successfully

In the soft tissue, epithelium that forms with titanium is

morphologically similar to that formed with the tooth.
Connective tissue doesn’t bond to titanium , but forms a
tight seal that limits the ingress of bacteria & bacterial
products.
 Mechanical properties-
Introduction
Dental materials are complex

They involve the mathematics of Engineering, the science

of materials, and arts of dentistry

Each of these is depended on the other, only together can

they be effective
 Definition:
Mechanical properties are subset of physical properties
that are based on the laws of mechanics that is the
physical science that deals with energy and forces and
their effects on the bodies

They are a measured response of material under an

applied force are distribution of forces

Elastic reversible on force removal

And plastic is irreversible or non elastic
Mechanical properties are expressed most often in units of
stress and stain.

They can represent measurement of

1) Elastic or reversible deformation

2) Plastic are irreversible deformation

3) A combination of elastic and plastic deformation such as

toughness and yield strength
Depending on the forces, types of stresses are classified:

a) Compressive stress

b) Tensile stress
c) Shear stress
d) Flexural (bending) stress
Compressive stress:
If a body is placed under a load that tends to compress or
shorten it, the internal resistance to such a load is called a”
compressive stress” a compressive stress is associated
with the strain here forces are directed to each other in a
straight line

Compressive stress develops on the occlusal side of the

FPD
Tensile stress:
A tensile stress is caused by a load that tends to stretch or
elongate a body. A tensile stress is always accompanied by
a shear strain,

Here forces act parallel to each

Tensile stress develops on the tissue side of the FPD

For a cantilevered FPD the maximum tensile stress
develops with the occlusal surface
Flexural Bending stress
Flexural Bending stress is produced by bending forces
and may generate all three types of stress in a structure. It
can occur in fixed partial dentures or cantilever structures
Mechanical properties measuring
reversible deformation
Elastic modulus
Dynamic young’s modulus
Flexibility
Resilience
 Poisson’s ratio
Elastic modulus (young’s modulus
or modulus of elasticity )
Definition : if any stress value equal to or less than the
proportional limit, it is divided by its corresponding strain
value, a constant of proportionality will result.
This constant of proportionality is known as the modulus
of elasticity or young’s modulus it is represented by the
letter E

E= stress
strain
Elastic modulus describes the relative stiffness or rigidity
of a material

Enamel has higher elastic modulus (3-4 times) then dentin

and is stiffer or more brittle, while dentin is more flexible
and tougher, ceramic have higher modulus then polymers
and composites.
 Elastic modulus of various
materials
Enamel 84.1
Dentin 18.3
Feld spathic porcelain 69.0
Composite resin 16.6
Acrylic denture resin 2.65
Cobalt – chromium partial 218.0
denture alloy
Gold (type-4) alloy 99.3
Dynamic Young’s modulus
Measured by a dynamic method,
Velocity at which sound travels through a solid can be
readily measured by ultrasonic longitudinal and transverse
wave transducers and appropriate receivers
The velocity of the sound wave and the density of the
material can be used to calculate the ‘elastic modulus’ and
‘Poisson ratio’ values
Poisson’s Ratio
When a tensile stress or compressive stress is applied to a
cylinder or rod, there is simultaneous axial and lateral
strain, within the elastic range, the ratio of the lateral to
the axial strain is called Poisson’s Ratio

Poisson’s = Lateral strain

Ratio Axial strain
Mechanical Properties based on plastic
deformation
1) Elastic limit

2) Yield strength

3) Proportional limit

4) Permanent (plastic) deformation

Strength is the stress necessary to cause either fracture or plastic

deformation.
Elastic limit
The elastic limit is defined as the maximum stress that a
material will withstand without permanent deformation.
 The elastic limit and the proportional limit represent the
same stress within the structure and the terms are often
interchangeable in referring to the stress involved.
They differ in that one describes the elastic behavior of
the material where as the other deals with stress to strain
in the structure.
Yield Strength
It is the stress at which the material begins to function in a
plastic manner, this yield strength is defined as the stress
at which a material exhibits a limiting deviation from
proportionality of stress to strain. It is used when
proportional limit cannot be accurately determined.
Proportional limit
Definition: The greatest stress that may be produced in a
material such that the stress is directly proportional to
strain.

Elastic limit, proportional limit and yield strength though

defined differently have close values but yield strength is
always greater
Permanent (plastic) deformation
If a material is deformed by a stress beyond its
proportional limit before fracture and the force removed,
The strain does not become 0 due to plastic or permanent
deformation,
Thus it refers to the stress which a material get
permanently deformed
It is the stress at which the material begins to function in a
plastic manner
Different types of strength
Diametral Tensile Strength
Flexure Strength
Fatigue strength
Impact strength
Diametral Tensile Strength
Compressive load is placed against the side of a short
cylindrical (specimens).

The vertical compressive forces produces a tensile stress

and fracture occurs along this vertical plane,

Tensile stress is directly proportional to compressive load

 Stress-strain curve for hypothetical material:
Proportional limit (A), elastic deformation (point A) and plastic deformation (between
points A & B). Point B represents the moment of rupture of the material under tensile
condition
Flexure Strength
This property is essential a strength test of a beam
supported at each end, under static load. It is a collective
measurement of all types of stress.

When the principal stress is applied, the specimen bends,

the principal stress on the upper surface are compressive,
where as those on the lower surface are tensile
Schematic illustration of flexural strength test
of a material
Fatigue strength
Stress values well below the ultimate tensile strength can
produce premature fracture of a dental prosthesis or
material because microscopic flaws grow slowly over
many cycles of stress.
This phenomenon is called fatigue failure

Fatigue strength is the endurance limit i.e. maximum

stress cycles that can be maintained without failure
Impact strength
It is defined as the energy required to fracture a material
under an impact force

A low elastic modulus and a low tensile strength suggest

low impact resistance
Other mechanical properties
Toughness
Fracture toughness
Brittleness
Ductility and Malleability
Hardness
Toughness
Toughness is defined as the amount of elastic and plastic
deformation energy required to fracture a material and is a
measure of resistance to fracture
Toughness is stress stain curve up to fracture and depends
on strength and ductility
Fracture toughness
Fracture toughness is a mechanical property that describes
the resistance of brittle materials to the catastrophic
propagation of flows under times the square root of crack
length i.e Mpa. M½ or tnN.M 3/2
Brittleness
Brittleness is the relative inability of a material to sustain
plastic deformation before fracture of a material occurs.
 It is considered as the opposite of toughness.
Ex. Amalgams, ceramics and composites are brittle at oral
temperature; They fracture without plastic strain.
Hence, brittle materials fracture at or near their
proportional limit however, a brittle material is not
necessarily weak
Ductility and Malleability
Ductility represents the ability of a material to sustain a
large permanent deformation under a tensile load before it
fractures. For example a metal that may be readily drawn
into a wire is said to be ductile
Malleabilityis the ability of a material to sustain
considerable permanent deformation without rupture
Most ductile and malleable metals –
Silver is second
Platinum is third in ductility
Copper is third in malleability
Measurement of ductility
3 common methods

Percent elongation after fracture

The reduction in area of tensile test specimens
The cold bend test
Percent elongation after fracture
The simplest and most commonly used method is to
compare the increase in length of a wire or rod after
fracture in tension to its length before fracture.
Two marks are placed on the wire or rod and is then
pulled apart under a tensile load
The fractured ends are fitted together, and the gauge
length is again measured, the ratio of the increase in
length after fracture to the original gauge length is called
the present elongation and represents ductility
 The reduction in area of tensile
test specimens
The necking or cone-shaped constriction, that occurs at
the fractured end of a ductile wire, after rupture under
tensile load, the percentage of decrease in cross-sectional
area of the fractured end in comparison to the original area
of the wire or rod is referred to as the reduction in area
The cold bend test
The material is clamped and bent around a mandrel of
specified radius, the number of bends to fracture is
counted, with the greater the number, the greater is the
ductility of the material.
Hardness
In mineralogy the relative hardness of a substance is
based on its ability to” resist scratching” In metallurgy and
most other disciplines, the concept of hardness is”
resistance to indentation”
Numerous properties like strength proportional limit and
ductility interact to produce hardness
Hardness tests
There are various scales and tests mostly based on the
ability of the material surface to resist penetration by a
point under a specified load, these test include
Burcol
Brinells
Rock well
Vickers and
Knoop
Brinell hardness test
One of the oldest test used to determining the hardness of metals
A hardness steel ball is pressed under a specified load into the
polished surface of a material the load is divided by the area of the
projected surface of the indentation and the quotient is referred to ad
Brinell hardness number or BHN
Brinell hardness test has been extensively used for determining the
hardness of metals and metallic materials used in dentistry.
 BHN is related to the proportional limit and the ultimate tensile
strength of dental gold alloys
Rockwell hardness test
It is some what similar to the Brinell test in that a steel
ball or conical diamond point is used.
Instead of measuring the diameter of the impression the
depth of penetration is measured directly by a dial gauge
on the instrument. Different indenting points for different
materials are used and designated as RHN

These two BHN and RHN are unsuitable for brittle

materials
Vickers Hardness test
Is the same principle of hardness testing that is used in the Brinell
test
Instead of a steel ball, a square based Pyramid is used.
Impression is square instead of round
The load is divided by the projected area of indentation and
designated as VHN
The Vickers test is employed in the ADA specification for dental
casting gold alloys
It is suitable for brittle materials, Hence used for measure tooth
hardness
Knoop Hardness test
This employs a diamond tipped tool cut in geometric
configuration.
The impression is rhombic in outline and the length of the
largest diagonal is measured the projected area is divided
into the load to give the KHN
The hardness value is virtually independent of the
ductivity of the tested material thus hardness of tooth
enamel can be compared with that of gold, porcelain,
Load can be varied from 1g to 1kg so that both hand and
soft materials can be tested
The knoop and Vickers tests are classified as micro hardness test

While Brinell and Rock well are macro hardness test.

Knoop and Vickers can measure hardness in thin object too

Other less sophisticated tests are SHORE and BARCOL to measure

hardness of materials like rubber and plastics, types of dental
materials.

These utilize portable indenters and are used in industry for quality
control the principle of these tests is alos based on resistance to
indentation
 Stress concentration factors of
material
Refers to the microscopic flows or micro and macro
structural defects on the surface or within the internal
structure
These factors are more accentuated in brittle material and
are responsible for unexpected fractures at stress much
below ultimate strength.
The stress is higher when the flow is perpendicular to
direction of tensile stress and flows on the surface
accumulated higher stresses
Areas of high stress concentration are caused by
following factors:
Surface flows i.e. voids are inclusions
Interior flows i.e. voids or inclusions
A sharp internal angle at the pulpal axial angle of a tooth
preparation for an amalgam or composite restoration
A large difference in elastic modulus or thermal expansion
coefficient across a bonded interface
Hertzian load i.e. applied at a point on a brittle material
There are several ways to minimize these stress
concentrations, thus reduce the risk of clinical fracture:
The surface can be polished to reduce the depth of the flow
Internal line angles of tooth preparation should be well
rounded to minimize the risk of cusp fracture
The materials must be closely matched in their coefficient
of expansion or contraction
The cusp tip of an opposing crown or tooth should be well
rounded distribute stress over a larger area for brittle
materials
Mechanical properties of tooth
structure and mastication forces
The mechanical properties of enamel and dentin varies one type of
tooth to another, within individual teeth than between teeth and
position of tooth.
That is cuspal enamel is stronger than enamel on other surfaces of
tooth stronger under longitudinal compression than lateral
compression
Dentin is considerably stronger in tension (50MPa) than enamel
(10MPa),
Compressive strength of enamel and dentin are comparable
The proportional limit and modulus of elasticity of enamel are higher
than dentin
Mastication or bitting forces varies mankedly varies from
one area of the mouth to another and from one individual
to another.
For the molar Bite force range from: 400 to 890N (90 to 200
pounds)

Premolar area : 222 to 445N (50 to 100 pounds)

Cuspid region : 133 to 334N (30 to 75 pounds)

Incisor region : 89 to 111N (20 to 55 pounds)

REFERENCES
Anusavice, Philips’Science of dental materials,11th
edition
G. Craig & John M. Powers, Restorative dental
materials,11th edition.
Combe, Notes on dental materials, 5th edition.
R.G. Craig, Review of Dental Impression Materials, Adv
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Chiara Coppi et al, Elite Implant- A Sterile, Radiopaque
and Biocompatible Impression Material, EDI case studies,
2(6): 46-50
Filiz Keyf, Some Properties of Elastomeric Impression
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Academy of Sciences, 1994 7(1), 44-48
M. Mikai, M. Koike & H. Fujii Quantitative analysis of
allergenic ingredients in eluate extracted from used
denture base resin, Journal of Oral Rehabilitation 2006,
33; 216–220
Linda WANG et al, Mechanical properties of dental
restorative materials, J Appl Oral Sci 2003; 11(3): 162-7
Sandra SATO et al, Assessment of Flexural Strength and
Color Alteration of Heat-Polymerized Acrylic Resins
After Simulated Use of Denture Cleansers, Braz Dent J
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