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BDS stage 2 > DMT Stage 2 part 2 > Flashcards

DMT Stage 2 part 2 Flashcards

1
Q

Which conditions require restoration ?

A

Fractures
Caries
Erosion and abrasion

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2
Q

What causes a tooth to fracture ?

A

trauma applies a high stress

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3
Q

What is enamel composed of ?

A

Biological apatite

A ceramic

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4
Q

What are the properties of enamel ?

A

hard but brittle

Relatively translucent

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5
Q

What is dentine composed of ?

A

A composite material- apatite and collagen

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6
Q

What are the properties of dentine ?

A

softer than enamel
tougher than enamel
opaque

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7
Q

Why is dentine tough ?

A

act as a shock absorber

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8
Q

What are the initial properties of a filling material ?

A

fluid and plastic so it can conform to the cavity

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9
Q

What must happen to properties of a filling material during setting ?

A

it needs to harden and strengthen - resist mechanical forces of mouth

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10
Q

In what way must filling materials be protective ?

A

protect the pulp from thermal and electrical changes

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11
Q

Which mechanical properties are important for filling materials ?

A

strength
stiffness
fatigue
toughness

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12
Q

Which 3 concepts are part of aesthetics ?

A

colour
shade - not possible for amalgam and gold
translucency - enamel is trnaslucnet but filling materials are opaque so not life like

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13
Q

Which factors can effect aesthetics in the long term ?

A

roughness- scratches can remove gloss and lead to colonisation
stains- food and drink can stain composites and amalgam tarnishes

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14
Q

Are enamel and dentine conductors or insualtors ?

A

insulators

low thermal condutivity and low thermal diffusivity

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15
Q

Is amalgam a conductor or insulator ?

A

a conductor - high thermal conductivity

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16
Q

How do we compensate for amalgams high thermal condutivity ?

A

Zinc oxide cmeent lining acts as an insulator

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17
Q

Do composites need insulator cements ?

A

not really

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18
Q

What are common allergies to materials ?

A

latex

nickel

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19
Q

Why is adhesion ideal ?

A

allows for conservative preparation

prevent microleakage

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20
Q

Which material expands on setting ?

A

amalgam

excessive expansion can lead to the filling protruding from the tooth and fracture of the tooth

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21
Q

What can absorption of water by fillings lead to ?

A

hydrolysis
softening - water acts as a plasticiser
leaching - positive and negative into oral cavity
staining

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22
Q

What are the factors in the oral environemnt the filling must endure ?

A

temperature variations- thermal cycling (5 to 60)

pH variations- alkaline conditions form medication and toothpaste

Solvent exposure- alcohol
corrosion- galvanation when dissimialr metals in contact

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23
Q

What is the pH of plaque ?

A

4

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24
Q

What can large dimensional changes lead to ?

A

stress at interface

percolation- pumping of food and bacteria round margins

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25
Q

What does high stress lead to ?

A

fracture

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26
Q

What does low stress over time ?

A

fatigue

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27
Q

What does rapidly applied stress lead to ?

A

impact

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28
Q

How does strength develop ?

A

setting time may be minutes or hours- long time for max strength to develop

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29
Q

How does the rate of development of strength impact on fillings ?

A

for the first 24h advise patients to not eat abrasively

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30
Q

What type of cavities can abrasion lead to ?

A

Class V cavity

V shaped

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31
Q

Can bacteria cause fillings to breakdown ?

A

bacteria cause resin breakdown

amalgam resist bacteria digestion

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32
Q

Should fillings be radiopaque or radiolucnet ?

A

radiopaque as caries is radiolucent

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33
Q

What determines the radioopactity of a material ?

A

its atomic number- the lower the atomic number the more radiolucent

composites are made from low atomic elements- need a radiopacifer adding

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34
Q

What does adding a radioopacifier do ?

A

lowers strength

compromise needed

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35
Q

What leads to a filling being technique sensitive ?

A

moisture control

numerous stages

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36
Q

Should working time be long or short ?

A

long to allow sufficient time for mixing and placing

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37
Q

Should setting time be long or short ?

A

short- for convenience

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38
Q

What is thermal diffusivity and what should it ideally be ?

A

thermal diffusivity is how a material reacts to transient thermal stimuli
it should be low
unless upper denture- should be high

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39
Q

What should the coefficient of thermal expansion be like for materials ?

A

similar to that of enamel and dentine

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40
Q

Why is a high modulus of elasticity beneficial for filling materials ?

A

allows a lot of elastic deformation before plastic occurs and permanently breaks marginal seal

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41
Q

What are the components of amalgam that ar mixed ?

A

liquid Hg
solid alloy powder
this is mixed
setting is via amalgamation to produce amaglam

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42
Q

Which metals are present in the alloy powder ?

A 
Ag
Sn
Zn
Cu
Hg sometimes
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43
Q

What is the role of Ag/Sn in amalgam ?

A

major component

combine to make the Ag3Sn gamma phase

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44
Q

What is the gamma phase ?

A

an intermatallic compound

Ag3Sn

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45
Q

What is the role of copper in the alloy powder ?

A

adds strength

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46
Q

What is the role of zinc in the alloy powder ?

A

acts as a scavenger
alloy is made in a high temperature where oxidation can occur
zinc reacts with the oxygen quickly removing it and saving the other metals from being oxidised
oxides severely affect the properties of the amalgam

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47
Q

What is a pre amalgamated alloy ?

A

alloy powder contains Hg already
these react more rapidly with Hg
most alloys arent pre amalgamated

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48
Q

Describe the setting reaction of dental amalgam ?

A

dissoloution of small alloy particles in liquid
Hg liquid dissolves into larger alloy particles
reaction to form gamma1 and gamma2
crystallisation of gamma1 and gamma2

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49
Q

Describe the structure of amalgam ?

A

core of gamma residual alloy (Ag3Sn)

matrix of reaction prodcuts- gamma1 and gamm2

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50
Q

Which has a higher tensile strength gamma or gamma1/2 ?

What is the consequence of this ?

A

gamma
need to control the amount of mercury- ensure that amalgamation happens but not too much that no gamma left to contribute to strength

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51
Q

Does amalgam have a higher compressive strength or tensile strength ?
What is the consequence of this ?

A

higher compressive strength of amalgam is higher
material is weak in thin sections as tensile strength is low
unsupported amalgam edges can fracture under heavy loads

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52
Q

What did convenional amalgams present with ?

A

ditching - marginal breakdown

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53
Q

What are the theories of ditching ?

A

creep model

corrosion model

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54
Q

Describe the creep model ?

A
  1. plastic deformation slowly and repeated over time
  2. leads to amalgam extending above the margins
  3. marginal fracture and ditch formation
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55
Q

What is thought to be responsible for creep ?

A

gamma 2 phase

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56
Q

What are the formuals of gamma 1 and gamma2 phases ?

A

gamma1- Ag2Hg3

gamma2- Sn7Hg

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57
Q

Describe the corrosion model of ditching ?

A

heterogenous multi-metal structure of amalgam makes it prone to corrosion
saliva is an electrolyte
gamma2 phase is more electrochemically reactive and forms anode
releases tin ions- weakens material and electrons which go to pulp

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58
Q

What does corrosion lead to ?

A 
discolouration 
Hg release
weakening 
metallic tastte
ditching
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59
Q

What is thought happens to the corrosion products ?

A

they gather margins between restoration and tooth and seal margins

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60
Q

What is the solution to ditching ?

A

get rid of gamma2 phase

resulted in modern amalgams

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61
Q

What is present in modern amalgams ?

A

increased copper

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62
Q

What doe sincreased copper in modern amalgams do ?

A

makes the gamam2 phase unstable so it doesnt form

copper compounds form instead

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63
Q

What are the copper compounds formed in modern amalgams ?

A

exist as 2 forms
Cu6Sn5
Cu3Sn

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64
Q

What is the role of palladium ?

A

some amalgams have been made with palladium and have lower corrosion/creep rates but suggests that something else might be causing ditching

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65
Q

What are the 2 types of alloy powder size ?

A

lathe cut

atomisation

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66
Q

What are lathe cut particles ?

A

alloy cast and made into ingots

filings are made from this- usually irregular in size and shape

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67
Q

What is atomisation ?

A

molten alloy sprayed into inert atmosphere and then solidifies and drops to the ground in spheres

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68
Q

What are the dimensional changes that occur in amalgamation ?

A

slight contraction when Hg diffuses into alloy partivles
slight expansion when the gamma1 and gamma2 phases crystallisation
overall might be slight expansion/contraction

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69
Q

What are the ISO ranges for expansion/contraction ?

A

-0.1 to 0.2%

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70
Q

What does a large contraction do ?

A

marginal staining- fluid- secodnary caries

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71
Q

What does a large expansion do ?

A

material protrudes- tooth fractures

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72
Q

What is the phenomenon of delayed expansion with amalgam ?

A

with zinc containing amalgams delayed expansion can occur some time after setting
zinc is contaminated with moisture
leads to liberation of hydrogen - delayed expansion
the need for adequate moisture control
however can use zinc free amalgams- made by atomisation in inert atmosphere

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73
Q

How does the strength of amalgam develop ?

A

slowly- over 24 hours so there is a risk of early fracture

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74
Q

Compare the strengths of amalgam ?

A

Strong compression strength

weak tensile strength and weak flexural strength

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75
Q

How does alloy particle size effect setting rate ?

A

smaller particles have higher setting rate

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76
Q

How should the cavity design for amalgam be ?

A 
Allows a sufficient bulk of amalgam 
undercuts provided
no unsupported enamel 
cavo surface angle is 90
internal line angles are rounded 
protective pulp lining 
can use bonding agent to occlude dentine tubules
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77
Q

Why do amalgam fillings require a protective pulp lining ?

A

amalgam has a high thermal diffusivity and is a conductor

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78
Q

Compare the coefficient of thermal expansion for enamel/dentine and amalgam ?

A

amalgam has a much higher coefficient of thermal expansion

risk of microleakage, percolation and expansion

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79
Q

What does the final amalgam strength depend on ?

A

the concentration of gamma phase (Ag3Sn)

ideally less than 50%

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80
Q

How were traditional wet amalgam mixed made ?

A

by trituration

in an 8:5 ratio

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81
Q

How are amalgam mixes made today ?

A

amalgamator and encapsulated prodcuts

allows mechanical mixing in a 1:1 ratio

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82
Q

How is amalgam in capsules ?

A

impermeable membrane separates alloy powder from liquid mercury
membrane shatttered by the amalgamator

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83
Q

Why do we use amalgam capsules ?

A

prevent mercury contamination

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84
Q

How is amalgam placed in the cavity ?

A

by condensation
an amalgam condensor is used
packed in increments whilst still plastic

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85
Q

Why is amalgam packed ?

A

reduce porosity

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86
Q

How is a cavity filled with amalgam ?

A

cavity is overfilled

mercury rich layer is carved back to reduce Hg content

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87
Q

Describe how different condensation forces are needed for different particle types ?

A

lathe cut particles have significant friction between them so require higher condensation forces

spherical particles have less friction between them so require smaller condensation forces

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88
Q

How does the intensity of the force applied correlate with Hg content ?

A

the higher the condensation force the lower the Hg content

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89
Q

What is significant about a lower Hg content in amalgam ?

A

a lower Hg content means less amalgamation allowing more gamma phase to remain and contribute to compressive strength

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90
Q

Why is amalgam carved ?

A

to remove the Hg rich layer

to carve the anatomy for the opposing tooth - contact

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91
Q

Why is the timing of amalgam carving important ?

A

if too soon- significant amounts of material dragged out

if too late- too hard

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92
Q

How far should amalgam be carved back ?

A

cut back the amalgam to the margins

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93
Q

Which type of amalgams are easier to carve ?

A

spherical and fine grain

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94
Q

When are amalgams polished ?

A

on the next visit - 24 hours needed to achieve max strength

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95
Q

Why is amalgam polished ?

A

improve apprarance
precent accumulation of debris
imrove corrosion resistance

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96
Q

What is used to polish amalgam ?

A

abrasives suspended in fluid like zinc oxide and chalk

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97
Q

What does polishing amalgam produce ?

A

a beilby layer

this layer has good corrosion resistance

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98
Q

What is the problem with mercury ?

A

its a neurotoxin

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99
Q

When is a patient subjected to mercury ?

A

during amalgam placement and through corrosion products

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100
Q

Which alloys release less mercury ?

A

gamam2 phase free alloys- less corrosion

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101
Q

How do allergic reactions to mercury manifest ?

A

lichenoid reaction
allergic contact dermititis
due to previous mercury sensitisation

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102
Q

What are potentially bigger sources of mercury ?

A

environmental- rocks and fossil fuels

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103
Q

Is there a global drive to reduce amalgam use ?

A

no- mercury use is wanting to be reduced not amalgam specifically

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104
Q

How does dentistry take into account mercury concerns ?

A

no amalgam use in pregnant women
no amalgam use in under 16s
well ventilated surgeries etc

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105
Q

What were silicate cements used as ?

A

direct tooth coloured fillings

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106
Q

What were the constituents of silicate cements ?

A

powder- fluoroaluminosilicate glass

liquid- 50% phosphoric acid

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107
Q

What is the setting reaction for silicate cements ?

A

acid/base reaction

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108
Q

What is the structure of silicate cements ?

A

composite structure - glass filler and matrix of reaction products

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109
Q

How are silicate cements mixed ?

A

by hand

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110
Q

What were the advantages of silicate cements ?

A

shade simialr to enamel
coefficient of thermal expansion similar to enamel
low thermal diffusivity
fluoride releasing

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111
Q

What were the disadvantages of silicate cements ?

A

weak and brittle
moisture sensitive during setting
do not adhere to tooth
solubility was pH-dependent- below 7.4 (normal saliva) the solubility increased significantly

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112
Q

Why were silicate cements phased out ?

A

introduction of GIC (similar acid/base and F releasing)

113
Q

What are acrylic resins ?

A

polymers based on acrylic monomers (monomers with acryalte bonds)

114
Q

How are acrylic resins made ?

A

powder and liquid are mixed
powder- PMMA, initiator and pigment
liquid- MMA and activator

115
Q

Why is pre- polymerised PMMA used in the polymerisation of acrylic resins ?

A

pre polymerised PMMA acts as a filler to reduce shrinkage during contraction

116
Q

How do acrylic resins set ?

A

free radical polymerisation reaction

117
Q

What type of reaction is free radical polymerisation ?

A

exothermic

118
Q

What were the advantages of acrylic resins ?

A

less acidic than silicates
less oluble than siliciates
low thermal diffusivity- insulators
tooth coloured

119
Q

What were the disadvantages of acrylic resins ?

A

setting is exothermic- can damage pulp
resisdual monomer can be left- tissue irritant
setting contraction
coefficient of thermal expansion very high- percolation and microleakage
flexible- marginal breakdown and destroyed by masticatory forces
no adhesion to enamel/dentine

120
Q

What is the problem with residual monomer ?

A

tissue irritant

acts as a plasticiser- makes acrylic resin more flexible

121
Q

What type of monomer is MMA ?

A

monofunctional
one c-c double bond only
small- low viscosity but high shrinkage

122
Q

What is meant by a composite structure ?

A

2 distinct phases formed by blending components
properties would not be achieved by not mixing the components
2 phases are the matrix and the filler
matrix- reaction products
filler- glass, pre PMMA etc

123
Q

Describe the composite structure of composie filling materials ?

A

matrix is resin

filler is glas

124
Q

What are the different components of composite fillings ?

A 
resin- matrix
glass-filler
coupling agent to bond matrix and filler 
stabiliser- extend shelf life 
radio-opacifier 
pigment 
initiator/activators
125
Q

Describe the problems of convnetional composites ?

A

they used simple quartz as a filler
and had to add radio-opacfier
this weakened the materials strength

126
Q

What was the solution to convnetional composites ?

A

increase glass filler contnet

127
Q

What happens as the glass filler content increases ?

A

hardness
rigidity
strength
increase

128
Q

What decreases as the glass filler content in composites increases ?

A

polymerisation shrinkage
coefficient of thermal expansion
exothermic temperature rise

129
Q

How can composites be classified based on filler size ?

A

conventional
microfilled
hybrid

130
Q

What are conventional composites ?

A

filler particle range from 1-50 um

filler volume is 50%

131
Q

What are microfilled composites ?

A

particle size from 0.01 to 0.1 um
filler volume is 30-60%
possible to achieve high filler content with high pressure and high temperature

132
Q

How are filler particles for microfilled composites made ?

A

combine glass particles with monomer and polymerise to make resin
resin shattered into small pieces
mixed with monomer and polymerised
pre polymerised glass filler surrounded by matrix

133
Q

What are the disadvantages of microfilled composites ?

A

the filler and matrix bind weakly

limits use to anterior cavities

134
Q

What are the advantages of microfilled composites ?

A

the filler particles are small- smooth surface and better gloss

135
Q

What are hybrid composites ?

A

particle size ranges from 0.01 to 20 um

60-80%

136
Q

What is advantageous about a range of particle sizes in hybrid composite s?

A

allows more efficient filler packing as small particles can fit between large particles
improved properties- allows them to be used posteriorly

137
Q

What are nanocomposites ?

A

produced with particles less than 1 um
build up method
small particles can lead to clumping
can also be nanohybrids

138
Q

Are there any advantages of nanohybrids ?

A

evidence in the lab only to suggest better wear resistance than microfilmed and hybrid

139
Q

Compare microfilled and hybrid composites ?

A

flexural and tensile strength greater for hybrid

140
Q

What is the problem with conventional composites and unfilled acrylic resins ?

A

still have high coefficient of thermal expansion - percoaltion

141
Q

What is the thermal diffusivity of composites like ?

A

considered insualtors

142
Q

What are alternative fillers to glass ?

A

amorphous silica
silica based glasses
colloidal silica
ceramics

143
Q

What is BisGMA ?

A

alternative to MMA for the matrix phase
difucntional- cross linked polymers are made
larger monomer- lower shrinkage but higher viscosity so blending filler is difficult
steric hindrance

144
Q

How does BisGMA display steric hindrance ?

A

aromatic groups make it harder for chains to move over each other- stiffer polymers

145
Q

What is TEGMA ?

A

a diluent monomer- used to dilute BisGMA and reduce its viscosity

less viscous but higher shrinkage as smaller monomer than BisGMA
difucntional

146
Q

Why are polymers made of BisGMA and TEGMA considered copolymers ?

A

made from more than one type of monomer- they are comonomers

147
Q

What are the problems posed by contraction setting ?

A 
microleakage 
marginal staining 
secodnary caries
enamel microcracks 
post operative sensitivity- leave to pulp
deonding
148
Q

Describe different monomers in order of contraction setting ?

A

MMA most shrinkage
TEGMA
BIsGMA

149
Q

How can we classifiy composites on handling characteristics ?

A

univerable
flowable
packable

150
Q

What is universal composite ?

A

useful for general work

151
Q

What is flowable composite ?

A

lower viscosity due to lower filler or more diluent monomer
weaker and less wear resistant
useful for lining or repair of non carious surface loss

152
Q

What is packable composite ?

A

higher viscosity ad more filler
needs to be packed- potential for porosity
useful for posterior restorations

153
Q

What are the alternative monomers to TEGMA and BisGMA ?

A

BisEMA
UDMA
Silorane

154
Q

Why do we need alternative monomers ?

A

BPA used in making BisGMA is related t health issues
(BPA free composites)
to get Better properties- handling and shrinkage

155
Q

What is UDMA ?

A

difunctional mathacrylate- makes a cross linked polymer
Low viscosity
High molecular weight
No BPA used in production

156
Q

What is BisEMA ?

A

ethoxylated BisGMA
low viscosity
little BPA

157
Q

What is silorane ?

A

different in that it undergoes ring opening not free radical polymerization - has an oxirane ring
undergoes slight expansion- might eliminate any shrinkage but not shown clinically

158
Q

Why is silane coupling needed ?

A

resins dont bond to silicates (glass)

applying heat and stress leads to pores between filler and matrix

159
Q

What happens in silane coupling ?

A

filler particles are pre treated- with a silane to allowmbetter bonding between matrix and filler

160
Q

What agent is used for silane coupling ?

A

silane agent
difucntional molecule- one end is like MMA and can bind to the resin and the other end is like a silane and can bind to the glass filler
bond forms between resin and filler

161
Q

What is problematc about silanes ?

A

they hydrolyse and breakdown

162
Q

What is advantageous about silanated composites ?

A

higher fatigue life than unsilanated composites

163
Q

How are chemically activated composite pastes made ?

A

liquid and pastes have to be mixed by hand

technique sensitive and can allow porosity to develop

164
Q

When does setting commence for chemcially activated composites ?

A

setting starts when mixign starts- working time is very small

165
Q

What are the characteristics of chemically activated polymerisation ?

A 
uniform rate
benzyl peroxide inittiaotr 
DMPT activaor 
residual monomer possible
increase in viscosity
166
Q

What is light activated polymerisation ?

A

light is delivered at the correct wavelength to activate polymerisation
command setting- unlimited working time

167
Q

What are the characteristics of light activated polymerization ?

A 
high degree of polymerisation- not much residual
non uniform rate however 
need an LCU
limited depth of cure - use increments
marginal stress develops
168
Q

What are the different types of light activation ?

A

visible light

UV light

169
Q

How does the depth of cure decrease ?

A

as the distance between composite and LCU increases

170
Q

Why is there a greater temeprature rise with light-activated composites ?

A

the heat is released over a short period of time when the LCU is placed

171
Q

Why is the light from the LCU blue ?

A

filters are used to remove the hotter parts of the spectrum

172
Q

Desrcribe UV light activation ?

A 
hand unit- but not visible 
2mm depth of cure 
benzoinmethyl ether initiator 
health risks- melanoma and cornel burns 
not used now
173
Q

What is visible light activation ?

A

vast majority use 470 nm wavelength
camphoroquinone photoinitiator - yellow
tertiary amine still used as an activator

174
Q

Compare UV and visible light activation ?

A

improved degree of polymerisation with visible light
no health risk with visible
improved depth of cure with visible light

175
Q

What are the different designs for LCUs ?

A

fibre optic cable- glass fibres used to break and reduce transmission
gun design- has a cooling element and bulk and is handheld as well as a timing system

176
Q

What is the conventional source of light in a LCU ?

A

QTH light bulb

need exposure for 20 secs

177
Q

Can plasma and LED sources be used ?

A

they are availabel in different wavelengths and need shorter exposure
filter out the unwanted wavelengths

178
Q

How do LEDs work as a light source ?

A

emit light over a narrow spectrum needed for CQ
environmentally friendly
no heat and only specific wavelengths

179
Q

What is the formula for radiant energy ?

A

li x exposure time

180
Q

What is the optimum light intensity for an LCU ?

A

16 J/ cm^2

181
Q

What is the optimuum exposure time for an LCU ?

A

10-20 secs

182
Q

What is light intensity related to ?

A

LED power output
distance of light form surface
correct alignment and full coverage

183
Q

What is the wavelenght needed or CQ ?

A

470 nm

184
Q

What are the alternative photoinitiators to CQ ?

A

PPD, TPO and BAPO

have their own specific absorption wavelengths so a specialist LCU is needed

185
Q

How should composite be dispensed ?

A

from a syringe into a pad

and taken from the pad with a spatula

186
Q

What are the stages of free radical polymerisation ?

A

activation
initiation
propagation
termination

187
Q

What happens in activation ?

A

activator allows the initiator to form radcials

188
Q

What happens in initiation ?

A

the radicals react with the monomer producing a molecule capable of further reaction

189
Q

What happens in propagation ?

A

molecule reacts with further monmers

this stage determines the molecular weight and the chain length

190
Q

What happens in termination ?

A

the viscosity has reached the gel point - the monomers can no longer come into contact with radicals
radicals cancel each other out
impurities can prematurely terminate the reaction

191
Q

How can oxygen prematurely terminate polymerisation ?

A

oxygen reacts a radical
this nullifies the radical and creates an oxygen radical
oxygen radical has a low reactivity- reaction terminated

192
Q

What does oxygen inhibition lead to ?

A

prematuretly terminated layer on top that is soft, weak and can be easily damaged

193
Q

What is the purpose of matrix strips ?

A

to prevent air inhibition
to guide the morphology of the restoration
to produce a glossy surface which reflects the matrix

194
Q

Why are composites polished ?

A

to remove any excess at margins and produce a smooth finish whilst maintaining the shape of the restoration

195
Q

What is the basic principle of polishing ?

A

start with the coarsest abrasive firdt and then gradually reduce the coarsness

196
Q

Is the polished surface glossier than the original matrix surface ?

A

no - the matrix surface will always be the smoothest possible

197
Q

Why do composite surfaces get rougher over time ?

A

the original matrix strip surface is rich in resin and soft
over time this is roughned away and the filler particles start to extrude from the surface
abrasion removes rich resin and gloss

198
Q

Why do microfilled composites retain a smooth surface better ?

A

the filler particles are smaller

199
Q

What does polishing do to surface roughness ?

A

polishing increasess surface roughness

200
Q

Why do composites stain ?

A

solvents soften resin
food and drink
acids get rid of filler and silane bond
CQ

201
Q

What does polymerisation shrinkage do ?

A

ruptures the adhesive seal at tooth interface
microleakage and secondary caries
enamel microcracks
fracture possibly

202
Q

What does the magnitude of shrinkage depend on ?

A

the size of the monomer- smaller means more shrinkage
degree of polymerisation- higher degree more shrinkage as polymer Is smaller than monomer
filler content
strength of adhesion
configuration factor
amount of diluent monomer TEGMA- more shrinage as smaller monomer

203
Q

What techniques have been devised to overcome shrinkage ?

A

incremental placement of composite

204
Q

What is the configuration factor ?

A

ratio of bonded surfaces : unbonded surfaces

205
Q

What does a higher C factor indicate ?

A

more stress will develop at tooth interface

more potential for shrinkage to cause a problem

206
Q

Where do the greatest C factors apply ?

A

with coating agents- a high proorption of the volume of the agent is made of bonded surfaces

207
Q

What is needed for successful light activated polymerisation for composite s?

A

good illumianation
incremental build up
single paste used- no porosity risk

208
Q

What needs to be consdiered during light activation ?

A

polymerisation is exo
greater temp rise in greater cavities
heat from LCU as well
greater cavities have less tertiary dentine- less pulp protection

209
Q

What is the biocompatabiltiy of composite ?

A

BPA used in production of BisGMA
residual monomer is cytotoxic and tissue irritant
tertiary amines and monomers are cytotoxic
polishing composites can lead to silica aerosls- penumosilicosis

210
Q

What is the biocompatability of amalgam ?

A

concerns over mercury use

211
Q

What has to be consdiered for cavity design for amaglam ?

A

is mechanically retained- need undercuts and grooves
needs a bulk
can destroy sound tooth tissue

212
Q

What has to be considered for cavity design with composite ?

A

might be more conservative as adhesive can be used

213
Q

How can composite margin seals be overcome ?

A

shrinkage

poor adhesion bond

214
Q

How can amalgam seal it margins ?

A

products of corrosion

215
Q

What is the hardness, toughness and strength like for amalgam and composite?

A

similar

216
Q

Is amalgam or composite more durable ?

A

amalgam- provided it is in bulk

217
Q

Do enamel and dentine adhere to composites ?

A

no

they require an adhesive

218
Q

What are some of the problems with trying to establish a bond ?

A

Time- adhesives take a long time to develop max strength
cavity size effect- larger cavities more reason for the bond to fail
lack of tooth affinity- resins are hydrophobic but tooth is hydrophilic
mouth is moist/warm- leads to thermal expansion/contraction

219
Q

What is the prerequisite for all adhesion ?

A

intimate contact

220
Q

What can get in the way of adhesion ?

A

surface roughness

221
Q

What is an adherned ?

A

a surface that is joined to another by an adhesive

222
Q

/Why are adhesives liquid usually ?

A

to allow intimate contact

223
Q

What is wetting ?

A

the ability of a liquid to flow over a surface and form a consistent film

224
Q

What is wetting dependent on ?

A

surface tension of the liquid

surface energy of the substrate

225
Q

What is surface tension of a liquid ?

A

in its lowest energy form tension can hold liquid into bubbles

226
Q

What is the surface energy of a substrate ?

A

the number of availbale bonds the surface can make compared to the bulk

227
Q

What does wetting require ?

A

the surface energy of the substrate is greater of the surface tension of the liquid

228
Q

What is the contact angle ?

A

the angle between bubble and the surface

229
Q

What can we do to the contact angle ?

A

lower the contact angle
this will lead to flattening of the droplet
increases the surface energy and lowers the surface tension

230
Q

What is a primer ?

A

alters the surface of the adhered so the adhesive can interact better with it
alters the surface energy

231
Q

What are the 3 bonding mechanisms ?

A

mechanical
chemical
complex

232
Q

What is a mechanical bonding mechanism ?

A

macromechanical retention- amaglam uses undercuts in cavities
micromechanical retention- liquids flow into microundercuts and form tags

233
Q

What is a chemical bonding mechanism ?

A

reversible or irreversible covalent and ionic bonds

subject to hydrolysis, temperature and pH changes

234
Q

What is a complex bonding mechanism ?

A

mixture of chemical and mechanical bonding mechanisms

235
Q

What are the obstales to bonding to enamel ?

A

the enamel pellicle - weakled edhered to enamel must be removed
the amorphous HaP layer- has a non hydroxyapatite structure and is formed during remineralisation so must be removed

236
Q

Describe the stages of the acid/etch technique ?

A

wash
etch
wash
dry

237
Q

Why is enamel etched ?

A

leads to etched structure
etched prisms act as microscale undercuts
resin can flow into the undercuts

238
Q

Why is enamel washed initially ?

A

to remove the pellicle

239
Q

How do you etch enamel ?

A

apply etchant which is 37% phosphoric acid
for 10-60 secs
can be liquid/gel and coloured for control
if left on too long- precipitation of phosphates

240
Q

Why do we wash the etchant off enamel ?

A

rinse enamel with oil free water

remove debris and etchant

241
Q

Why do we need to dry etched enamel ?

A

reveal frosty appearance

bonding resins are hydrophobic and the enamel is hydrophillic- must dry as much as can

242
Q

What must you avoid during etching ?

A

salivary/moisture contamination

must re etch if contaminated

243
Q

What is bonding via etching sufficient for ?

A

resisting composite shrinkage

244
Q

Why cant you apply a composite directly to etched enamel ?

A

low viscosity - BisGMA is a large molecule

filler particles are large and can occlude the undercuts

245
Q

What do you apply before the composite to enamel ?

A

Bonding resin

246
Q

What are the properties of enamel bonding resins ?

A

similar monomer composition to the composite
fluid
originally unfilled

247
Q

How do bonding resins set ?

A

light set- viscosity is consistent and can enter the microundercut
chemically set- mix 2 pastes, viscosity will increase and might compromise ability to enter micorundercut

248
Q

What is the action of bonding resins ?

A

enter microscale undercuts and form resin tags
leads to micromechanical retention
mechanical bonding only

249
Q

What are applications of the acid/etch technique ?

A

class IV cavities- proximal incisal edges
fissure sealnts
orthodontic brackets
resin bonded bridges

250
Q

What is the structure of enamel ?

A

highly clacfied prisms
96% apatite
3% water
1% organic

251
Q

What is the structure of dentine ?

A

tubular structure
70% hydroxyapatite
20% collagen
10% water
both hydrophilic and hydrophobic components
impossible to obtain dry field- tubules are always pumping fluid

252
Q

What are the concerns with applying the acid/etch technique to engine ?

A

acid applied to vital dentine- damage the pulp ?
now thought ineffective marginal selaing- acid irritation

would need to dry dentine before bonding resin is applied which is hydrophobic and the dentine is hydrophilic

253
Q

In what circumstances does dnetinal tubular fluid decrease ?

A

in anaesthetised teeth
adrenaline is vasconstrictor to pulp blood vessels
less tubular fluid which is a direct exudate of the pulp blood vessels

254
Q

What is the smear layer ?

A

gelatinous layer that is weakly chemically bonded to dentien and prevents the adhesive bonding to bulk dentine
formed from cavity prep- contains debris- dentien chips, collagen, microbes, salivary protein and collagen
covers the entire surface of prepared dnetine

255
Q

Why do we need to deal with the smear layer ?

A

to form an effective bond between the adhesive and the engine

256
Q

How can we deal with the smear layer ?

A

remove it in the total acid etch approach- you will end up bonding to bulk dentine

modfiy it with weak acid or self etching primer and you will bond to a mix of modified smear layer and engine

257
Q

What is the stage called where we deal with the smear layer ?

A

conditioning- equiavalent of acid etch

258
Q

Why is the priming stage carried out after conditioning ?

A

designed to change the chemical nature of the dentine surface to overcome the repulsion between the hydrophilic dentine and the hydrophobic monomers in the resin

259
Q

What is the most commonly used priming agent ?

A

HEMA

260
Q

Which molecules are used for priming agents ?

A

difunctional molecules
one end is a methacryalte group- can bind to the bonding resin
the other end is a reactive group that has affinity for moist dentine

261
Q

What is the general structure of a priming agent ?

A

M-S-R
M is the methacrylate groups which binds to the bonding resin and can polymerise

S is a spacer that allows flexibility and viscosity

R is the reactive group and can have an affinity for moist dentine -

262
Q

What does HEMA stand for ?

A

Hydroxyethyl methacrylate

263
Q

What type of molecule is HEMA ?

A

amphiphillic- hydrophobic and hydrophillic componenets
hydrophobic- methacryalte
hydrophilic- OH group

264
Q

Does the primer carry out mechanical or chemical bonding ?

A

mechanical bonding to the dentine in the hybrid layer only has affinity for dentine via OH group
not chemically bonding

265
Q

What is 10 MDP ?

A

another primer molecule
might have possible chemical bonding on the dentine
contains phosphate group which can bind to calcium in the dentine

266
Q

What happens after priming ?

A

the dentine is now more hydrophobic and able to bind to the resin

267
Q

What does the conditioning do ?

A

smear layer removed or modified

demineralises dentine and leads to 3D collagen network

268
Q

What happens to the collagen network ?

A

the primer and the resin can infiltrate the 3D collagen network forming the hybrid layer

269
Q

How does infiltration affect bond strength ?

A

poor infiltration of the primer and resin in the hybrid layer leads to weak bond strength

Good infiltration leads to strong bond strength

270
Q

What type of structure does the hybrid layer have ?

A

composite structure

2 phases- resin and collagen phases

271
Q

What would happen if we dried dentine after conditionng ?

A

this would lead to pulp damage

leads to collapse of the 3D collagen network

272
Q

What is the dilemma with drying conditioned dentine ?

A

we need to dry dentine to make hydrophobic for the monomers but drying leads to collagen network collapse so we dont get a hybrid layer

273
Q

How do we get over the dentine drying dilemma /?

A

we use displacing primers

the primer contains water/solvents like ethanol that will displace the water around the collagen fibrils

274
Q

What is the total etch approach for dentine ?

A

use 37% phosphoric acid
this will remove the smear layer and demineralise the dentine leading to the collagen network

you have to rinse the acid

can bond to wet dentine

275
Q

What is the self etch approach for dentine ?

A

use a self etching primer or a weak acid
HEMA in maleic acid
you dont need to rinse the acid off
the smear layer is not fully removed so the dentinal tubules are not exposed directly- less post op sensittivity ?

276
Q

What are dentine bonding resins like ?

A

difucntional methacrylate
bond to the primer methacrylate
bond to the methacryalte groups in the composite

traditionally unfilled

277
Q

What are the stages of dentine bonding ?

A

conditioning - remove smear layer and get collagen network
priming - make dentine hydrophobic
bonding- bonding with resin - infiltrate the tubules and make hybrid layer with primer

278
Q

How long does it take for bond strength to develop ?

A

24 hours
takes 20secodns for the composite to cure so there is a disparity between bond development and curing - can lead to marginal failure

BDS stage 2 (28 decks)

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