Advanced Restorative and Biomaterials MT1

• 3 weeks (because there is an expansion of composite up to 15 microns)
• If the sensitivity is to cold (it is because of an open margin) a white line can be seen
• The white line is a marginal gap (interface is 11 margins) usually 70 microns can be detected.
• Marginal gaps can be caused by over adjustment. Best one can be done with Carbide burs on slow speed, An etch and adhesive can be added to the margin and polymerized to seal that margin.

If not hyperoccluded, it is an adhesive problem.

• 20 seconds enamel, 10 seconds in dentin
• It takes 5 seconds for the adhesive to penetrate 5 microns
• Scotchbond universal does not require etch (on dentin) step and avoid the overdrying or wetting that leads to adhesive failure

• Hue - true colors of rainbow (4 hues used in dentistry) A-Brown, B-yellow, C-gray, D-red. Cervical is the best area to choose the Hue.
• Chroma - difference between a strong and soft color. (difference between A2 and A3 is the more saturated color).
• Value - difference between light and dark within the color. A2B (the third color is the value). More value is more WHITE (dentin, body), less value is more grey/dark (enamel/trans).
• - 80% of patients are A
• - 20% of patients are B
• *Spectophotomefer (used to see shades)

• Post
• Metal restorations
• Zirconia/Alumina crowns

• Base past activator (tertiary amine)
• Catalyst past: Initiator (benzoyl peroxide)
• This is different than the light cured which have photo activation
• CANNOT use the same adhesive as the composites

• 1. Because of the color (we don't want change) 2. more time to work with and remove access as well as check adaptation.
• Scotchbond universal can be used because the light cure resin cement is the same as composite.

• 1- ceramic inlay/onlays
• 2. lithium disilicate crowns (e. max, some light can be passed through)
• 3. indirect composite restorations

• Glass- gives more esthetic and translucent quality
• Crystalline- gives more strength/resistant

• 1- feldspathic (glass based), weakest but most popular for veneers
• 2- Leucite reinforced (glass based with leucite filler), Impress esthetic, increase the resistance a bit, used a lot. indicated for laminate veneers, inlays/onlays and crowns
• 3- Lithium disilicate reinforced (glass based with lithium disilicate filler EMAX). increased resistance, can use for Bridges, no prep/occlusal veneers. Use thinner preparations.
• 4- Zirconia yttria stabalized (crystalline based system). Used for infrastucture coping and implant abutments (biological response in bone level implants with adhesion of fibroblasts). Full mouth reconstructions, molars.

• Powder/liquid - used for high esthetic results. It can be technician sensitive, many changes have to be done. Gingival tissue can be made as well.
• Press - feldspathic, leucite reinforced and lithium disilicate. can be mixed with powder/liquid technique for more esthetics
• CAD/CAM - Computer guided made from a block. easiest with lower price. great results for minor chance of errors. can be mixed with powder/liquid.
• Future - 3D printing

• 1. HF acid (5-10%)
• 60 seconds - feldspathic and leucite
• 20 seconds - lithium disilicate
• 2. Wash with water and ultrasound
• 3. Saline (1 min)
• ** Zirconia does not get HF acid or Saline to prime. Primers are used to prep the inside (scotchbond has the properties)

• Broken down teeth with intact Buccal and Lingual wall
• MOD with wide isthus
• Endo treated posterior with sounds B and L structure

• Insufficient structure for bonding
• Poor oral hygiene
• rubber dam cannot be placed
• more than 2 cusps missing including functional cusp on 2nd molar

• Same as for amalgam restoration
• MOD inlays that can be kept narrow are only acceptable for molars
• Inlay that is 1/3 the facio-lingual width of the occlusal surface can WEDGE the cusps apart *weakens cusps, cement seal compromised, leakage loss of cusp

• 2 layers
• 1. coping made of dense sintered aluminum-oxide 
• 2. crown made of allCeram low fusing surface porcelain
• *Ceramic shrinks 20-25%
• *Incisal edge of ceramic prep can be reduced until flat as long as reduction does not exceed 3mm
• *Short preps are contraindicated in all ceramic crowns

• The forces and material on the opposing arch, if natural dentition is on the opposing arch, Cerec CAD/CAM Paradigm is a type of composite (Paradigm Infiltrated Ceramic Network PICM) that can be used
• Ceramic can oppose ceramic
• Felspathic (Vita and Sirona blocks)
• Pressed
• Empress - Cad and Emax
• All ceram (Procera)

• No Hydrofluoric acid
• No firing or glazing, with easy finish
• Xray radio-opaque
• VITA ENAMIC (by VIDENT) uses 70% ceramic and composite it is a PICN

70%

Celtra DUO, is a CAD/CAM block for chairside use with the Sirona Cerec-Unit

• 1- size of the proximal box
• 2- cervical wall of the proximal box (accessible) too deep?
• 3- restoration of cusps (cannot be done in mouth)
• * the usual problem with class 2 is the proximal box margin and leakage
• * Indirect restorations will have better mechanical properties and adaptation

• Fill from the margins to the center
• Glass ionomer should only be used when absolutely necessary under composites, research shows they do not work well together.

• Small inlays and onlays: lab composites are preferred.
• Overlays and large onlays: Ceramics are preferred (when reconstruct more than 2 cuspids)

• The polymerization process
• **The future is going toward composite restorations, they can be repaired chairside which is a huge advantage.

Short term use or devices that sit on top of tissue. Dental floss, tongue depressor, surgeon gloves,  crowns, dentures

class 3 (implants are classified as class2 along with the abutment which does not go inside the body, so it can be sold in the same pkg)

• Biocompatibility
• New def: UPDATED, Ability of a material to perform with appropriate response in a specific application (because no material is biologically inert.

Off-label use, is against the FDA altho not enforced, can lead to legal action.

Osseointegrative

Osteconductive - bone actually attaches

Osseoinductive - molecular event

Nanostructure

Microstructure

• Smooth surface is needed, to help spread proliferation. 
• ROUGH SURFACES INHIBIT CELL SPREADING