biomimetic materials used in conservative dentistry & endodontics
TRANSCRIPT
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Nature is the mystery and chasing andunfolding that mystery is human nature.
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Biomimetic materials
used in
Conservative Dentistry &
EndodonticsPresented by:
Dept. of Conservative Dentistry & EndodonticsGuru Nanak Institute of Dental Sciences & Research
Kolkata
Dr. Tirthankar Bhaumik, Dr. Antava Maiti, Dr. Debojyoti Majumdar, Dr. Monojit Roy
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• Starting from prehistoric era man behavedsimilarly to animals in hunting and makingshelter for survival.
• In the legend of Icarus & his father
Daedalus, inspired by birds, made wingsfrom feathers and wax for them to escapefrom prison.
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• In the real world, Leonardo da Vinci in the15th century dreamed of fabulous flyingmachines based on birds, although it was notuntil the 20th century that the Wrightbrothers successfully created a prototypethat led to the modern aircraft of today.
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• So these revolution from flying birds totodays aircraft reflects the human’s nature ofmimicking the Nature’s secrets.
• Thus Nature acts as a motivation factor whichlead to development of new era of science—
Yes, it is
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BIOMIMETICS
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CONCEPT OF BIOMIMETICS
AND
BIOMIMETIC MATERIAL
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WHAT IS BIOMIMICRY ?
Biomimicry is the science and art of emulating Nature's best biological ideas to solve human
problems.
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In biomimicry, we look at nature as model, measure, and mentor.
Janine Benyus1997,Biomimicry
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After 3.8 billion years of evolution, nature has learned
What works. What is appropriate. What lasts.
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Biomimicry introduces an era based not on whatwe can extract from organisms and theirecosystems, but on what we can learn from them.
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Examples….
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Mimicking can be done by using either
Natural substitutes
or
Synthetic substitutes
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Why synthetic materials are preferred?
• More availability
• Relatively easier synthesis
• Reduced risk of pathogen transmission
• Biocompatibility
• Biodegradability
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Synthetic mimicking• Structural
• Functional
• Esthetic
• Structural-functional
• Biological process mimicking
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WHAT IS BIOMIMETICS?
Biomimetic refers to human-made processes, materials, devices, or systems that imitate nature.
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Materials
Processing & tools
Fabrication/Manufacturing
Devices & machines
Functions & Mechanisms
Principles
Almost all engineering could be thought of as a form of biomimicry
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Scope of Biomimetics
• Biomedical science
• Dentistry
• Electronics
• Materials scientists
• Chemists
• Geologists
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What is Biomimetic material?
A material fabricated by Biomimetic
technique based on natural process
found in biological systems is called a
biomimetic material
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Don’t Confuse
with…
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Bioactive material
A bioactive material is one that elicits a specificbiological response at the interface of thematerial which results in the formation of abond between the tissues and the material
Hench LL, Splinter RJ, Allen WC, Greenlee TK Jr.; Bonding mechanisms at the interface of ceramic prosthetic materials. J Biomed Mater Res., 1972; 2:117-141
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Bioactive material
Osteoproductive(45S5 Bio glass)
Osteoconductive(Synthetic HA)
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Key points
of
biomimetic
materials
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1) Should be synthetic in origin
2) Should mimic biology
3) Should bond with natural structure
4) Should not elicit any biological responses
Advanced Ceramics for Strategic Applications, Prof. H. S. Maiti, Department of Mechanical Engineering, Indian Institute of Technology, Kharagpur , Lecture – 47, Bio ceramics
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HISTORY
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• The foundation of this broad new field hasancient roots.
• First or second century AD- Evidence ofcrude dental implants seen in romanpopulation and the first use of dentalamalgam was recorded in pre-Columbiancultures of central and south America.
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• 659 AD- use of heart pacemaker the artificialheart valve and hip and knee joint arewritten in Chinese literature.
• 1960 - The subject of copying, imitating, andlearning from biology was coined Bionics byJack Steele
• 1969- Otto Schmitt, an American academicand inventor, coined the term biomimetics
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• 1974- The term biomimetics only entered theWebsters Dictionary.
• 1982- The term biomimicry appeared.
• 1997- The term biomimicry was popularizedby scientist and author Janine Benyus in herbook ‘Biomimicry: Innovation Inspired byNature.’
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Biomimetic materials used in Biomedical Science
• PMMA (acrylic), Silicone- Intra ocular lens, Breast implant
• Titanium & its alloys, Polyether ether ketone (PEEK)- Artificial hip joints,
Dental implants
• Polyurethane, Teflon & Dacron- Vascular grafts
etc……
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Biomimetic dentistry
• The use of dental materials and technologies that mimic tooth structure and function.
• Maintaining as much natural tooth structure as possible.
• Materials should absorb and distribute stress like tooth structure and should bond with natural structure.
• Enamel like materials.
• Dentin like materials.
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Biomimetic materials
used in
Conservative Dentistry
and Endodontics
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Why?
Natural hard tooth structure once lost forany reason is not ever reproduced by thebody system, hence dependence onsimulating materials becomes essentialfor restoring it to form and function.
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• Some of the materials simulate toothmaterials but additionally exhibit some bio-active properties.
• These materials are clubbed together in thegroup of bioactive material
• e.g.-
MTA,
Biodentine,
Synthetic hydroxyapatite etc..
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1) Glass ionomer cement
2) Dental composite material
3) Dental ceramics
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Definition
• Glass-ionomer is the generic name of a
group of materials that use silicate glass
powder and aqueous solution of polyacrylic
acid” -Kenneth J Anusavice.
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Composition
Conventional Glass-ionomer cement
Basic Component Calcium aluminosilicate
glass containing fluoride
Acid Component
Polyelectrolyte which is a
homopolymer or copolymer of
unsaturated carboxylic acids
known scientifically as
alkenoic acids.
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GLASS-IONOMER CEMENT is a Biomimetic
Material
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Because ,
1. It is synthetic
2. It does not form any natural tooth structure.
3. It’s similar mechanical properties to dentin.
4. Adheres chemically to the tooth structure
5. Less shrinkage ,so less microleakage
6. Dimensional stability at high humidity
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Elastic Modulus (Gpa)
Thermal Expansion Coefficient(ppm)
Ultimate Tensile Strength (Mpa)
Ultimate compressive strength (Mpa)
Hardness (KHN)
Enamel ~82 ~10 ~384 350-430
Dentin ~40-105 ~297 ~68
Conventional GIC
~4.5 196-251 87-177
~11
~10-11
~14
~4-10
~8
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• Properties of GIC not adequately matching it’s biomimetic behaviour
1. Low Tensile strength
2. High opacity (Contrast ratio- 0.9 )
3. Less Wear Resistance
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Modifications of Glass-Ionomer
• 1) Water settable GIC
• 2) Metal modified GIC
• 3) Resin modified GIC
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Metal modified GIC –
• Glass ionomer have been modified by addition of filler particles ,to improve fracture toughness & resistance to wear with different results.
• Disadvantages-
Poor aesthetics
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Alteration of Biomimetic property
• Inspite of modification the mechanical properties did not reflect much improvement. Compressive strength ,flexural strength and solubility remained same .
• Wear resistance- wear resistance of silver cermet cement is somewhat improved over traditional glass ionomer cement.
• Esthetics- By the incorporation of silver particle it takes away the estheticproperty of glass ionomer .
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Resin modified GIC –
It may be auto-cured, Light-cured, dual-cured depending on activator initiator system.
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• Alteration of Biomimetic properties –• Optical properties- Improved from
conventional GIC, as translucency improved.
• Strength- The diametral tensile strength is much higher but compressive strength and hardness is lesser.
• Adhesion- Bond strength of resin modified glass ionomer with dentin is higher than that of conventional G.I.C
• Microleakage- Increased due to polymerization shrinkage of resin
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N-vinylpyrrolidone (NVP) or N-vinylcaprolactam(NVC) containing GIC –
• NVP or NVC co-monomers when incorporated in GIC they act as a spacer in between itaconic acid and acrylic acid, thereby increasing the degree of freedom of side chain carboxylic group for reaction.
• AA-IA-NPV (Fuzi IX) mechanical properties--
Compressive strength-277 MpaFlexural strength- 46 MpaDiametral Tensile strength-21.6 Mpa
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GIC as Biomimetic Material
• Glass-Ionomer cement is extensively used to replace Dentin, hence it is called as
• Dentin Substitute
• Man made Dentin
• Artificial Dentin
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Restorative including deep cavities
LutingGIC as Biomimetic
Material in Conservative
Dentistry
Liner & BasesMinimum Intervention
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Restoration of Non Carious Cervical Lesion with G.I.C
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Class V caries restored with G.I.C
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Restoration of Class I cavity with G.I.C
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GIC as base
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GIC as a luting agent
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• GIC as Biomimetic Material in Endodontics –
• Intracanal Rehabilitation, reinforcement-• To ensure a better prognosis in cases like flared canal
where intraradicular dentin thickness is very less, “Reinforcement Technique” should be followed.
• The intraradicular reinforcement method includes placing a thick intermediate layer of adhesive material, sandwiched between the root dentine and a small-diameter metal post or dowel, to improve the fracture resistance of such roots , which acts as a dentin substitute.
• GIC is one of the preferred dentin substitute here, as a biomimetic material.
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Core Build up –
• The metal reinforced glass ionomer cements are used for this purpose
• Glass ionomercements reinforce the teeth
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Glass-ionomer based sealer
• Glass ionomer based sealer has been advocated for use in obturation because of their dentin bondngproperty
• It enables adhesion between the material and canal wall
• Disadvantage-It has minimum anti bacterial property
• Removal is difficult in case of retreatment
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Root canal perforation repair—
• GIC can be used to repair perforation during root canal procedure as dentin substitute.
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• Calcium
phosphate i.e
hydroxyapati
te
substituted
with
carbonate
ions.
• Ions of
Strontium,Mg
,lead,Fl.
Inorganics,96% by vol.
ENAMEL
Organics & water,4% by vol.
• Proteins like
enamelins..
• Ameloblast
cells
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DENTIN
Organics20% by wt.,33% by vol.
Calcium 26.9%
Phosphorous
13.2%
Carbonate
4.6%
Sodium 0.6%
Magnesium
0.8%
• Collagen 90%
• Proteins
• Lipids
Water10% by wt.,22% by vol.
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Materials formed from two constituents that are insoluble in one another, forming a material with properties that are superior or intermediate to those of the constituents but at the same time maintaining their own characteristics..
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I Resin Matrix :BIS-GMA or Urethane
Dimethacrylate (UDMA) +
Dimethacrylate monomers (TEGDMA)
II Inorganic Fillers :
Quartz/Glass Particles (0.1 to 100µm)
Colloidal Silica (0.02 to 0.04 µm)
CONTENT 30-70% vol.
50-85% wt.
III Coupling Agents : organosilanes
IV Pigments : oxides of titanium
ACTIVATOR:Tertiary amines
PHOTO-
INITIATOR:Camphorquinone
CHEMICAL-
INITIATOR:Benzoyl Peroxide
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Esthetics
The Influence of Dental Anatomy
Dental anatomy and contour influence the color of the teeth and esthetic restorations.
Dentin gives teeth a more opaque (dense) appearance than enamel.
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Variation of shade
• Acc. to age:In younger patients, enamel and dentin are thicker, and
more opaque and less translucent, in the
incisal area. In newly erupted permanent incisors, the
mamelons are present and result in a
dense, slightly darker, yellowish area at the incisal edges.
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• Whether enamel or dentin is exposed
• Acc.to the vitality of the tooth:
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Physics, Light and Color
• The hue is what we would typically think of as “color”.
• The chroma is the degree of saturation or purity of that hue.
• The value is the degree of lightness or darkness of the color or material and ranges from black (value 0) to white (value 10).
Acc. to the Munsell system
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The type of light under which color/shade is
judged
influences the perception of color/shade.
A shade must mimic the translucency and opacity
of the
tooth in order to be able to blend in.
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• Ask patient to remove lipstick.• Place a light blue/grey/white bib over the patient’s clothing.• Select shades at the start of the appointment and before prep-ping the
tooth.• Select shades after removal of any significant extrinsic stain on the
adjacent dentition.• Place the shade guide tab at arm’s length from your eyes.• Place the shade guide tab alongside the patient’s surrounding dentition.• Look for only a few seconds at a time to avoid eye fatigue that would
influence shade selection.• Use the shade guide recommended by the composite manufacturer.• Consider the light source – natural daylight is best. • Use more than one source of light.• Ensure that the shade taker has been tested for color blindness and has
no such abnormality.
Other Shade Influencing Factors
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MEGAFILL : >100 µm
MACROFILL : 10 - 100 µm
MIDIFILL : 1-10 µm
MINIFILL : 0.1 - 1 µm
MICROFILL : 0.01 - 0.1 µm
NANOFILL : 0.005 – 0.01 µm
Shade of composite depends on
Size of filler particleFiller content influences
esthetics; micro-filled and
nanofilled composites contain
microscopic filler particles that
scatter light, whereas hybrid
resins are less esthetic.
Shape of filler particleLight-scattering is also
influenced by the shape of the
filler particles – multifaceted
particles scatter and reflect light
in different directions, and
nanofilled composites transmit
light more than other
composites.
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When performing shade selection, first the hue, then the chroma and then the value are chosen. If using a Vitapan shade guide, this
order will result first in choosing from A-D for the hue, then selecting from within that group
for the chroma. Lastly, the value is selected based on degree of lightness/darkness and
may result in a different shade being viewed as an alternative.
When using a composite resin, the manufacturer’s
recommended shade guide must be used to ensure the best
match possible of the restoration with the teeth.
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Digital Shade
guide
Vita 3D Shade Guide
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flexural
strength
modulus of
elasticity
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UNFILLED TRADITIO
NAL
MICRO-
FILLED
SMALL
PARTICLE
HYBRID
COMPRE-
SSIVE
STR.(MPa)
70 250-300 250-300 350-400 300-350
TENSILE
STR.(MPa)
24 50-65 30-50 75-90 70-90
ELASTIC
MODULUS
(GPa)
2.4 8-15 3-6 15-20 7-12
CO-EFF. OF
THERMAL
EXP.
10-6
/0C
928 25-35 50-60 9-26 30-40
KHN 15 55 5-30 50-60 50-60
ENAMEL DENTIN
384 297
10 52
84 18
16.96×10 10.59×10
68343
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BONDING..
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FIRST GENERA
TION
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WHICH ONE SHOULD WE CHOOSE
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Generation classification of bondingagents does not exist anymore. It wasofficially withdrawn by its introducerDr. Marcus Vargas during 5th IndianaConference held at University Centreon June 2000.
Marketing gimmicks are being playedby various manufacturers givinggeneration classification to theirsystems on their own.
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From that time the classification
of bonding agents have been
classified as –
(a) Total etch.
(b) Self etch.
Kuraray was the first company to
manufacture the first dentin bonding
agent of the world in 1978 called Clearfil
Bond System – F, which gave birth to
adhesive dentistry based on the
research of Prof. Fusayama and clinical
trials by Dr.Raymond Berttoloti.
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Formation of a hybrid layer involving dentin collagen & resin.
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Dentin immediately after application of Self
Etching Systems
Demineralization of dentin 20 s after application
of Self Etching Systems forms retentive resin
tags
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Lower right lateral incisor with etched Class IV preparation
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Placement of bonding agent
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Light-curing of bonding agent
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Class IV restoration during light-curing
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Class IV restoration after light-curing
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Completed Class IV restoration
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COMPOSITE RESIN is a Biomimetic Material
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Good esthetics
Long term color stability
High hardness & compressive
strength
Chemical inertness
Excellent biocompatibility
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CERESTORE
DICOR
LITHIUM DISILICATE
ALUMINOUS CORE
PORCELAIN
LEUCITE RE-INFORCED
IPS EMPRESS
CERAMICS
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Modulus of elasticity(Al2O3)-350GPa
Fracture toughness(Al2O3)- 3.5 to 4 MPa.m1/2
Flexural Strength-
1) Platinum foil Method- 139 to 145 Mpa
2) Dry pressing and Sintering(15500C)-600MPa
Fracture toughness: 1.6-
2.1MPa.m1/2
Flexural strength 81 ± 6.8
Mpa
Marginal adaptation :
Avarage
Flexural strength-upto 112MPa
Fracture toughness- 0.9 to 1.3 Mpa.m1/2
Esthetics : high esthetic value
CERESTOREFlexural strength-150MPa
Fracture toughness- 1.79
MPa.m1/2
Flexural Strength- 350 MPa
Fracture toughness- 3.3
Mpa.m1/2
It is fairly translucent but
somewhat more opaque.
ALUMINOUS CORE PORCELAIN DI-COR
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CERESTORE
Excellent fit & marginal integrity.
Radio-density similar to that of
enamel.
Advantages
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STAINS
Stain is more concentrated than the color modifier
They can be supplied as pure metal oxides but are
sometimes made from lower fusion point glasses.
Used as surface colorants or to provide enamel check
lines, decalcification spots
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The wear properties of indirect dental composites and all-ceramic materials were compared with each other by in vitro tests. Human teeth were used as antagonists and their wear loss was calculated and the overall properties of a composite are found to be influenced by the volume fraction and types of fillers. The results of this study indicate that indirect dental composite is relatively more wear-friendly than all-ceramic restoration. As for the wear loss of the enamel antagonist, indirect composites are favorable and less offensive. Therefore, the second generation of indirect composites is promising in long-life dental restorations. Int. J Oral Sci. 2013
Dec; 5(4): 183-190.
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Knoop hardness, wear rate, mean friction coefficient and wear loss of antagonist
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Studies Results, mean wear (s.d.)
Occlusal wear of ceramic crowns Occlusal wear of opposing natural
teeth
Suputta-mongkol 2008
Wear volume/mm3 Premolar 0.19 (0.06) Premolar 0.21 (0.06)
Molar 0.34 (0.08) Molar 0.50 (0.22)
Wear height/µm Premolar 29 (12) Premolar 46 (13)
Molar 36 (34) Molar 65 (29)
Etman 2008
Procera
Wear in µm after 6 months 143.60 (9.47) 130.96 (15.08)
Wear in µm after 12 months 201.18 (0.22) 184.24 (15.02)
Wear in µm after 18 months 243.70 (7.31) 216.84 (14.14)
Wear in µm after 24 months 321.60 (12.79) 261.58 (12.88)
Experimental ceramic
Wear in µm after 6 months 108.50 (4.87) 102.02 (8.49)
Wear in µm after 12 months 148.16 (6.38) 149.7 (6.59)
Wear in µm after 18 months 194.18 (11.92) 193.92 (12.07)
Wear in µm after 24 months 214.76 (4.9) 214.86 (6.09)
MC
Wear in µm after 6 months 87.06 (2.96) 75.52 (7.15)
Wear in µm after 12 months 116.3 (4.70) 106.9 (10.19)
Wear in µm after 18 months 142.30 (3.91) 133.82 (6.94)
Wear in µm after 24 months 176 (3.93) 156.42 (14.34)
Silva 2011 (at year 3 in mm3)
MC 1.48 (0.20) 1.10 (0.10)
IPS e.max Press without
veneering
1.06 (0.12) 0.80 (0.09)
IPS Empress 2/IPS Eris 1.31 (0.17) 1.02 (0.20)
Wear results of the teeth and their opposing crowns obtained in the reviewed studies
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T h e H u n t i s s t i l l o n . . ! ! !
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Recent Advancement in
Biomimetic Material
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FIBER REINFORCED GICIt involves incorporation of a continuous network / scaffold of alumina and SiO2 ceramic fibers
•Flexural strength increased(15.6 Mpa)•Compressive strength increased (200Mpa)•Fracture Toughness—0.22 Mpam0.5
This technology is called the Polymeric Rigid Inorganic Matrix Material or PRIMM
Alumina and SiO2 ceramic fibers
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Nano-Hydroxyaptite/yttria stabilized ZIRCONIA (HA/YSZ) containing GIC
Here HA/YSZ is added to GIC. Nano-Hydroxyaptite/yttria stabilized ZIRCONIA (HA/YSZ) containing GIC defines a new class of restorative glass ionomer that promises the strength and durability ideal for permanent posterior restoration maintaining aesthetics.
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• (HA/YSZ) stabilized ZIRCONIA containing GIC–
Elastic Modulus (Gpa)
Thermal Expansion Coefficient(x106)
Ultimate Tensile Strength (Mpa)
Ultimate compressive strength (Mpa)
Hardness (KHN)
Enamel ~82 ~17 ~10 ~384 350-430
Dentin ~14 ~11 ~40-105 ~297 ~68
(HA/YSZ) stabilized ZIRCONIA containing GIC
~15 215-346 104-106245~15 ~11-14
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(HA/YSZ) stabilized ZIRCONIA containing GIC
• Strength and durability match to enamel and amalgam
• Packable and condensable like amalgam
• No hazard of mercury, the risk of corrosion, expansion and thermal conductivity
• High flexural modulus and compressive strength
• Chemically bonds to enamel/dentin
• Tooth-like co-efficient of thermal expansion
• Excellent resistance to abrasion and erosion
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Clinical applications of Nano-Hydroxyapatite/yttria stabilized ZIRCONIA
(HA/YSZ) containing GIC1. Class I & II cavities2. Structural base in sandwich restorations3. Core build-up under indirect restorations4. Root surfaces where overdentures rest5. Pediatric and Geriatric restorations6. Long-term temporary replacement for fractured
cusps7. Fractured amalgam restoration8. Suitable for ART techniques
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Preparation of Class I Cavity Restored with (HA/YSZ) stabilized ZIRCONIA
containing GIC
“white amalgam”•.
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PROLINE CONTAINING GLASS IONOMER CEMENT
• Amino acid (glycin, ß-alanin, glutamic acid) are incorporated in GIC to increase the degree of freedom of side chain amino acids to increase salt bridge formation.
• Compressive strength increased (193-236 Mpa)
• Flexural strength increased (55-71 Mpa)
• Surface Hardness increased (52.3-64.5 VHN)
• Indication-
• Class v cavity restoration
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Nano Glass Ionomers (Nano-Ionomers)
• Nanotechnologies have been applied to the resin modified glass ionomers in the form of nanoparticles (nanomers) and nanoclusters in fluoro-alumino-silicate (FAS) glass.
• Increased polishability• Increased aesthetics
• Decreased compressive strength (48 KHN)
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• INDICATIONS 0F NANO-IONOMERS -
• Class III, class V cavity restoration
• Primary teeth restoration
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Advanced Ceramics
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Cercon
It is Zirconia based smart ceramics.
1. Metal-free restoration, increased aesthetics2. Fracture toughness (5-10 Mpa.m1/2) increased3. flexural strength (800-1300 Mpa) increased4. Resistance to crack formation and propagation
increased.
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Copping
Cerconas
BiomimeticMaterial
Closed Bite
Full Crown
Elevated Occlusal
Force
High wear and tear
Bruxism
High Musculature
Less Inter-occlusal Clearance
Short Crown Hight
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Full Crown Preparation By
Cercon
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Still today there is no perfect Biomimetic material
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A perfect biomimetic restorative material that contains all the synthetically manufactured ingredients of enamel, dentin separately including Hydroxyapatite crystal with all their natural properties, that can be applied directly on the lost tooth structure to restore enamel, dentin respectively.
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Future scope of Biomimetic Material
• Future scopes of Biomimetic Materials in Conservative Dentistry and Endodontics still now is potentially dynamic.
• The Dental profession continues to look for one perfect material, the “Holy Grail” of dentistry, to replace two very different structural components of the tooth ( enamel and Dentin), simultaneously.
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Equia®System
It is an upcoming system. Inorganic silica nanofillers (40 nm size) are dispersed in liquid and reinforce the resulting polymer matrix.
1. Better resistance to dissolution, disintegration and wear
2. Highly polishable surface3. Maintenance of polished surface
for a longer period of time 4. Enhancement of optical
properties and translucency
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Equia®System
Many studies claimed that Equia®System is as good as of natural teeth, means towards the goal of a perfect biomimetic material.
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Nano hydroxyapatite (HA) and Nanofluoroapatite (FA) incorporated GIC –
• Nano-HA and Nano-FA particle size-100-150 nm
1. Increased bond Strength
2. Filling of demineralizing micro-pores in the tooth structure
3. Compressive strength(210 Mpa when 5% wt HA is added), diametral tensile strength and biaxial flexural strength increased.(when Ethanol is added)
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• Research is going on a number of materials such as alumina, alumina/titania, zirconia and yttria stabilized zirconia incorporation in GIC
• There are very high expectations from this on-going research on nanomaterials.
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Nano-endodontic Sealer
• It is worldwide hot topic for researchers.
Composition-
– calcium silicate
– calcium phosphate
– calcium hydroxide
– zirconia
– thickening agent (hydroxypropyl methylcellulose)
– Bentonite
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• Biomimetic properties of Nano-endodontic Sealer --
On hydration reaction in root canal during it’s setting calcium silicate and hydroxyapatite is formed, which adopt to irregular dentin surfaces and can rehabilitate the lost intra-canal dentin.
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Conclusion
• Replacement of diseased or lost tooth structure with biomimetic materials is currently the technique of today which will fulfil our dreams. Yes, ‘Future is coming, it will be amazing’
• But future advances in this field will require materials and computer scientist , physicist , bioengineers, clinicians, biologist and related industries working together towards a shared vision rather than pursuing their separate objectives..
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