5. Biocompatibility of Dental Materials Flashcards

1
Q

Biocompatibility
• Definition:
The ability of a material to generate a proper ____ response in a given application in the body.
Being harmonious with life, not having a toxic effect or injuring biologic function.

A

biologic

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2
Q
Elements of Biocompatibility
– No local \_\_\_\_ effects
– No toxic components with \_\_\_\_ effects
– No \_\_\_\_ components
– No \_\_\_\_ potential
A

local
remote
allergenic
carcinogenic

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3
Q

Systemic Effects

Produced by the substance release by the material when:
• Ingested and absorption in the ____ track
• Inhaled ____
• Released at the ____ apex
• Absorption thru the oral mucosa

Systemic biological responses
to a dental material depends on:
• the \_\_\_\_ and concentration of the exposure
• the \_\_\_\_ rate of the substance
• the site of the \_\_\_\_
A
gastrointestinal
vapor
tooth
duration
excretion
exposure
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4
Q

Allergic Reactions
• Type I: ____
• Type II: ____ hypersensitivity reaction
• Type III: ____hypersensitivity reaction
• Type IV: ____ hypersensitivity reaction

A

anaphylaxis
cytotoxic
immune complex
delayed or cell-mediated

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5
Q

Carcinogenic Effect
• Carcinogenicity: Ability to cause ____. (no dental material shown to be ____)
• Mutagenicity: Ability to cause alterations on the ____ base-pair sequences.
MUTAGENIC ≠ ____

A

cancer
carcinogenic
DNA
carcinogenic

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6
Q

Regulating Bodies
• ____–Food and Drug Administration
• ____–American National Standards Institute
• ____–American Dental Association
• ____–International Organization for Standardization

A

FDA
ANSI
ADA
ISO

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7
Q
Role of ADA, FDA
• \_\_\_\_ for standards/ Revision of standards
• \_\_\_\_ program
• Applications for material \_\_\_\_
• \_\_\_\_
A

guidelines
certification
compliance
complaints

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8
Q

ADA Activity on Biocompatibility
• 1972
– Recommended ____ Practices for Biological Evaluation of Dental Materials
• 1979- Revised Edition
• New Document
– ____ Evaluation of Biocompatibility of Medical Devices used in Dentistry- Test Methods (International Standard)

A

standard

preclinical

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9
Q

Evaluation of biocompatibility of medical devices used in dentistry (11/25/2008)

  • ISO7405:2008 specifies ____ methods for the evaluation of biological effects of medical devices used in dentistry. It includes testing of ____ agents that are an integral part of the device under test.
  • ISO7405:2008 does ____ cover testing of materials and devices that do not come into direct or indirect contact with the patient’s body.
  • ISO7405:2018 (updated October)
A

test
pharmacological
not

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10
Q

Evaluation sites of Biocompatibility

  • Localized Toxicity-____ and surrounding soft tissue
  • Systemic Responses-From ____ toxic materials in circulation
  • Allergenicity -Potential ____ agents
  • Carcinogenicity-____ potential
A

pulp
diffusible
sensitizing
carcinogenic

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11
Q
Tests for Evaluating Biocompatibility
• Sequential testing to reduce number of \_\_\_\_ that will need to be tested clinically
• Three levels of evaluation
– \_\_\_\_ Tests
– \_\_\_\_ Tests
– \_\_\_\_ Tests – \_\_\_\_ Usage Test
A
compounds
primary
secondary
tertiary
preclinical
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12
Q

Testing Strategy
• Primary Tests: ____ and in-vivo test, but not necessarily related to the use of the ____.
• Secondary Tests: are more advanced ____ test that may be ____ related to the use of the material.
• Usage Tests: are either clinical trials in ____ or a close model of the use of a ____ in higher animals.

A
in-vitro
materials
biological
partly
human
material
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13
Q
Primary Tests
• Cytotoxicity
– \_\_\_\_ culture studies
– Membrane studies
– \_\_\_\_ membrane lysis (hemolysis)

• Genotoxicity
– Evaluation of ____ changes on cells, bacteria, yeast or fungi
– ____ mutations, other genetic changes
– Mutagenesis and ____ at the cellular level

A

tissue
red blood cell

genetic
gene
carcinogenesis

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14
Q

Cell Culture techniques
• Zone of inhibition of cell growth
• ____ days

A

1-3

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15
Q

Primary Tests- Cytotoxicity
• ____ overlay Method
• Consequences of short term ____ of chemicals from the surface of materials
• Release of ____ by dead cells

A

agar
leachability
neutral red

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16
Q

Primary Tests
• Cytotoxicity through
____ disk

A

dentin

17
Q

Secondary Tests
• Systemic toxicity
– LD50 after ____ day administration: the amount of the substance required to kill 50% of the test population. A lower LD50 indicates increased ____

• Inhalation toxicity
– Rats, rabbits, guinea pigs in ____ chamber – ____ of toxicity can be determined

A

14
toxicity

inhalation
levels

18
Q

Secondary Tests

• Inflammatory or \_\_\_\_ potential - dermal irritation, \_\_\_\_ and sensitivity tests
• Skin irritation
– with no \_\_\_\_ activity
• Sensitization
– with \_\_\_\_ activity 
• guinea pigs
A

immunologic
implantation
antibody
antibody

19
Q
Secondary Tests
• \_\_\_\_ Tests
• Short and long term, for \_\_\_\_ inflammation, or tumor formation
- Short term tests in \_\_\_\_ tissue
- Long term tests in \_\_\_\_ or bone
A

implantation
chronic
subcutaneous
muscle

20
Q

Tertiary Tests Preclinical Usage Tests
• Placement of the materials in their intended contexts
– Larger ____ and then humans
• ____ and dentin usage tests
– Subhuman ____, dogs, miniature pigs
– Positive and ____ controls – Histology after ____, 28, 70 days

A

animals
primates
negative
7

21
Q

Preclinical Usage Tests

Pulp capping/ pulpotomy tests
- CaOH is ____ control
– Test period ____ days and 70 days

Endodontic usage tests
– ____ control
– Test period - ____ days/13 wks

A

negative
7

ZOE
28

22
Q

Mucosal and Gingival Usage Tests

  • Reactions to ____ cavity preparations and restorations
  • Histological response after ____ days and 30 days for slight, moderate or severe responses
  • Eliminate inflammation due to ____ and restorative procedures before evaluations
A

subgingival
7
prophylaxis

23
Q

Dental Implants

• Successful implantation- criteria
– no ____
– no radiographic evidence of ____ radiolucency
– minimal ____ bone loss and absence of peri-implant ____ complications.

A

mobility
peri-implant
vertical
soft tissue

24
Q

FDA Approval

• Primary and secondary tests
– Product will not be harmful to ____
• For dental products manufacturer has ____ years to prove efficacy
• ____ term data required for drugs and implant materials - for FDA

A

humans
7
long

25
Q

Screening(1o,2o) vs. Usage Tests

• ____ correlation between screening and usage tests
• Modulating factors
– ____ barrier between material and pulp
– ____ effect of cell culture
– ____ occurring in usage tests
– Accumulation of ____ plaque around restorations

A
poor
dentin
buffering
microleakage
bacterial
26
Q
Adverse Effects of Dental Materials
• \_\_\_\_
• Inflammation 
• \_\_\_\_
• Mutagenicity
A

toxicity

allergy

27
Q

Allergic Responses to Dental Materials
• Primary irritant dermatitis-____ dependent
• Allergic contact dermatitis - non ____ dependent
– most common ____ disease
– Interval between exposure and clinical manifestation - ____-48 hrs
– Effect occurs at site of ____

A
dose
dose
occupational
12
contact
28
Q

Allergic Responses to Dental Materials

• Allergic contact dermatitis - non \_\_\_\_ dependent (contd)
– A prior \_\_\_\_ exposure is necessary
– Orthodontists and pedodontists 
• 50% of \_\_\_\_, 1% patients
– \_\_\_\_ of bonding agents, acrylic resin
A

dose
sensitizing
personnel
monomers

29
Q

Allergic Contact Stomatitis
Common Allergens in dental Materials
• ____, cobalt, ____, eugenol, MMA monomer, bonding resin, ____, components of composite resin, gold
• Tests - ____ test

A

chromium
mercury
formaldehyde
patch

30
Q
Latex allergy
• True latex allergy
• Allergy to reactants in \_\_\_\_
• 6-7 % of surgical personnel
• Localized \_\_\_\_ & swelling
• Wheezing and \_\_\_\_
• Repeated and prolonged exposure increases \_\_\_\_ of response
• Use vinyl or \_\_\_\_ gloves
A
processing
rashes
anaphylaxis
degree
nitrile
31
Q
Nickel Allergy
• 10% \_\_\_\_ population
• 1% males
– less exposure to \_\_\_\_ plated jewelry
• 30% of patients with \_\_\_\_ allergy react to nickel containing dental restorations
A

female
gold
previous

32
Q

Beryllium Allergy and Toxicity
• Caused by inhaling ____ dust
• Grind beryllium containing alloys with ____ and adequate ventilation

A

beryllium

masks

33
Q

The Mercury Controversy
• Inorganic mercury & methyl mercury
• Mercury in the ____ chain
• Ingested mercury- poorly ____
• Inhaled mercury is ____
• No direct relationship between ____ fillings and blood mercury levels
• Recognized symptoms of mercury poisoning
– ____, fatigue, anorexia, weight loss, ____, irritability, shyness, dizziness, and ____ of the extremities

A
food
absorbed
retained
amalgam
weakness
insomnia
tremors
34
Q

Dental Iatrogenesis
Creation of problems/complications from dental treatment
• ____ Preparation
• Remaining ____ thickness • ____ use of materials

A

cavity
dentin
wrong

35
Q

Dentin Structure Variation with depth & Age

• Variation of size & density of tubules with region
• Older patients
– deposition of reparative ____
– Less ____ tissue
– Less ability to recover
from ____
– Avoid ____ irritations due to dental Tx

A

dentin
pulpal
injury
pulpal

36
Q

Microleakage

• Ingress of bacterial and toxic products towards ____

A

pulp

37
Q

When is a material biocompatible?
When the material has the ability to perform with an appropriate host ____ in a specific application, and not producing ____ effects.

A

response

adverse