FILLING MATERIALS in Pedodontics

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FILLING MATERIALSin Pedodontics
SEMMELWEIS UNIVERSITY BUDAPEST Department of
Pedododntics and Orthodontics
Dr. Rózsa Noémi Dr. Déri Katalin
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Materials

• Filling materials
• short term temporary
• long term temporary
• definitive
• underfilling materials
• Endodontic materials
• Prophylactic, preventive materials
• fissure sealer
• varnish, gel
• Impression materials
• Luting materials
• cements
• orthodontic bonding

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Temporary FM

• Characteristics
• non toxic
• good retention
• good marginal adaptation
• easy to apply and to take out
• aesthetic
• not expensive

• Short-term setting under wet conditions
• Long-term Zink-oxyd-eugenol cement (ZOE)
• Endodontic GIC, ZOE
• Inlay
• temporary light curing composite
• gutta-percha

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Underfilling materials

• Effects
• Temperature stability, isolation
• Protection
• Elektric stimulation
• Mechanical and chemical effects
• Therapeutical action
• - antiinflammatory
• - dentinbridge
• Dentine tube obliteration
• Antibacterial

• Thickness
• Varnish 1-50µm (dentin-sealer)
• Liner 0.2 1mm Ca(OH)2, GIC
• Base 1-2mm cements

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Underfilling materials

• Cink oxy-phosphate cement
• liner fast setting,
• luting long setting,
• No obliteration of the dentintubes
• pulp phosphoric acid
• in vitro citotoxic, mutagen
• setting acid-basic reaction

• cinc-oxyd-eugenol cement (ZOE)
• good marginal sealing
• eugenol low bacteriostatic and pain
  releasing
• long-term TF
• base - deep cavity
• - under composit filling

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Underfilling materials

• Polycarboxylate cement
• Phosphoric acid ? polyacrylic acid
• Setting acid-base reaction
• Tooth structures chemical binding
• in vivo ? toxicity
• in vitro ? - Zn, F-, mutagenic
• ? mechanical properties, ? solubility
• difficult handling

• Calcium-phosphate cement
• good biocompatibility
• Setting acid-base reaction
• pulp capping
• under development

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Underfilling materials

• Calcium-hydroxide - Ca(OH)2
• antiseptic
• facilitates dentin formation
• Ca(OH)2 release /absorption results week
  structure
• self-curing - ? solubility
• - ? mechanical properties an other
  application, GIC
• underfilling, direct and indirect pulp capping
• light-curing - ? solubility
• - ? mechanical properties
• - 0,5 1mm pulplesion, under amalgam
• - ? toxicity

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MINERAL TRIOXIDE AGGREGATE MTA
Torabinejad et al. - 1995

• 1993 lateral root perforation
• retrograde root filling,
• direct pulp capping,
• bifurcation perforation,
• apexification.

pH 12,5 Ca(OH)2
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Glassionomer cement GIC

• reactive glassparticules (composite inert glass)
• setting acid-basic reaction
• sandwich technique
• ion F-, Al3, Sr2
• structure - calcium-aluminium-fluor-silicate
  glass
• - strocium-aluminium-fluor-silicate glass
• Polyakrilic acid/polycarbonate acid
• glass-polyalchenoate cement

• liner dentin gt 1 mm
• fissure sealing
• prosthetic preparation
• temporary filling
• definitive filling - primary molars

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Glassionomer Cement - GIC
Type Advantage Disadvantage Indication
Traditional self curing F- release No Adhesive technique aesthetics Powder/liquid proportions Mechanical properties Primary molars
Dual setting Fissure sealing Colour (pink) Long-term water absorption FS Cervical erosions TF
Resin reinforced GIC insensitive to moisture aesthetics 1 polym. shrinkage allergy Pulpal lesions underfilling prosthetic Small occlusal cavity
Hard, fast setting F- release Water absorption, water release Exact dosage mechanical properties aesthetics Primary molars TF, underfilling prosthetics
CERMET (Metal reinforced GIC) traditional GIC aesthetics, ?F- Primary molars
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GIC

• CERMET CEMENT

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INDICATION GC Fuji VII or Triage

• Molars short after eruption or partially erupted
  - FS
• Allergic reactions
• Barbie filling in primary dentition.

Pink colour
Dual setting glassionomer cement Chemical
setting 230 Light-curing 2O
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GC Fuji Triage
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GC Fuji Triage or VII

• Additional indications

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GC Fuji II LC
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Amalgam

• Quantity
• Cu contents
• low 2-5 - conventional
• high 12-30 - non-gamma-2
• Form lt 20-25 µm
• lathe-cut plate
• spherical
• Irregular form
• mixed

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Amalgam
Conventional amalgam Conventional amalgam Conventional amalgam Conventional amalgam Conventional amalgam Conventional amalgam Conventional amalgam Conventional amalgam Conventional amalgam
Ag3Sn Hg ? Ag2Hg3 Sn8Hg Ag3Sn
?-phase ?1-phase ?2-phase ?-phase
High Copper amalgam High Copper amalgam High Copper amalgam High Copper amalgam High Copper amalgam High Copper amalgam High Copper amalgam High Copper amalgam High Copper amalgam High Copper amalgam High Copper amalgam
Ag3Sn Cu3Sn Hg ? Ag2Hg3 Cu6Sn5 Ag3Sn
?-phase ?1-phase ?-phase ?-phase

• corrosion
• mercuroscopic expansion
• Hg

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Primary Dentition - Amalgam
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Amalgam
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Composite filling materials

• min. two, chemically different material and one
  phase 3D combination

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Composit Filling Materials
Special composites Filler type Properties
Ormocers Organically modified ceramic cross linked polysiloxan in the organic matrix ?polym. shrinkage good resistance to abrasion difficult to polish
Insert - Glass for Molars megafiller 0,5 -2,0 mm occlusal contact difficult to apply special polym. technique
Modified heterogen/homogen composites modified filler fibre, crystal better physical
Flowable composites Flow HK - ? filler fissure sealant base for composites
Condensing compozites ? filler gt 80 molars ? aesthetic ? viscosity HK
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Compomer

• Special composite,
• Composition
• bifunctional monomer - composite
• Reactive glass filler GIC
• Setting
• - free radical polymerisation
• - acid-basic reaction (water absorption from the
  environment, 3 max. water content, during
  several month)? chemical setting material and
  tooth
• ? F-
• Light curing ? filling material
• Self curing ? luting cement

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Twinky Star

• Light curing coloured compomer
• Primary dentition
• Alternative amalgam
• Radiopaque
• F-
• Compliance

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Twinky Star

• Oba AA, Sönmez IS, Sari S.
• Clinical Evaluation of a Colored Compomer
• In Primary Molars
• Med Princ Pract 2009 1831-34
• 36 patients ? 80 II. class fillings, primary
  dentitions
• M/F 1 12 month
• Minimally invasive technique
• 2 mm thickness, 40
• Results
• 3,9 (3 fillings) replacement
• 1,3 caries
• 1,29 (1 filling) - fracture
• 2,6 - marginal shinkage
• 2 fillings marginal discolouration

F pink, silver M lemon, blue
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MagicFilTM

• Coloured compomer
• Dual setting
• Insensitive to moisture
• F- , Zn2 ? bactericidal
• Setting 40 ? 4
• Croll TP. MagicFil A colourful kiddie compomer.
  Compend Contin Educ dent 2002 231044-1048.
• Jafaranta B, Soderholm K-J, Guelmann M. Light
  penetration and bond strength of MagicfilTM to
  primary molars. Baltimor Convention Center 2005.
• blue lt white lt purple lt yellow

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Stainless steelcrowns

• primary molars
• occlusal rehabilitation
• long-term solution
• time-consuming preparation
• cementation.

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Stainless steel crowns

• Tooth preparation and
• crown adaptation

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Stainless steel crowns
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Aesthetic crowns

• PedoPearlsTM (1980)

Whiter Biter Crown II
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Aesthetic crowns

• Kinder Krown Pedo II colour discrepancy, easy
  to apply
• Kinder Krown Pedo I, White Steel Crown not
  suitable

Source Hosoya Y, Omachi K, Staninec M.
Colorimetric values of esthetic stainless steel
crowns. Quintessence Int 2002 33537-541.
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Aesthetic crowns

• PedoPearls (1980)

• polyester/epoxi hybrid coated prefabcricated
  aluminium crowns
• minimal occlusion
• contactpoint metal
• selfcuring or dual curing composit

• Indication
• primary dentition

• Contraindications
• bruxism
• severe orthodontic anomalies

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Aesthetic crowns

• NuSmileR

Source Th. Croll. Restoring four primary
incisors using NuSmile Primary Crowns.
Paediatric Restoration, 2007 Dental products
Report Europe
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Aesthetic crowns

• NuSmileR

Source Th. Croll. Restoring four primary
incisors using NuSmile Primary Crowns.
Paediatric Restoration, 2007 Dental Products
Report Europe
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FISSURESEALANT MATERIALS

• Bis-GMA
• GIC

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Bis-GMA adverse effects

• LOCAL
• - CARIES INCIPIENS sealing
• - pulp phosphoric acid
• - gingival irritation - fluoride
• SYSTEMIC
• - allergy, anaphylactic reaction ,asthma
• - carcinogenic, teratogenic

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CleanProTM
Colour changing Fissure sealant
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CleanProTM No rinse sealant technique

• Self etching 15 - AdperTM PromptTM L-PopTM
• No need for rinse
• Only for occlusal surfaces

• self curing fissure sealer

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EMBRACE - WetBond

• Insensitive to moisture
• No bond necessary.

Pulpdent,J.P.ODonnell
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InTen-S

• Light curing composite
• ? polym. shrinkage 1,6
• Cavity preparation I V, FS, primary dentition,
  ceramic veneers reparation

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VOCO ADMIRA SEAL

• ORMOCER based
• organically modified ceramic
• biocompatibility
• minimal shrinkage
• better adhesive properties
• high filled 54
• 0,7 µm ø glass ceramic parts
• thixotropic.

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VITAL AMPUTATION (PULPOTOMY)
PUPLDRESSING MATERIALS

• Medication for damaged primary pulps.

controversy discussion for many years

• Calcium hydroxide Ca(OH)2
• MTA
• Iron sulphate Fe2(SO4)3
• Formocresol after Buckley (1904)
• Glutaraldehyde 2-5.

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ROOTCANAL FILLING MATERIALS
PROPERTIES

• No irritation
• Form stability
• Radiopaque
• No solubility
• Wall coating
• (biocompatibility)
• Antiseptic and bacteriostatic
• Easy to remove
• No discoloration.

British Endodontic Society Guidelines for root
canal treatment
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ROOTCANAL FILLING MATERIALS

• ADULT ENDODONTIC THERAPY

Composition Product name Company
Cink-oxyd-eugenol Aptal Harz, Hermetic Speiko Lege Artis
Epoxyresin AH26, AH26 Plus Dentsply DeTrey
Metacrylate Polyhydroxi-metilmetacrylate Hydron Hydron Canada
Polyketon Diaket ESPE
Polydimetil-siloxan Roeko Seal Automix Roeko
Salycilate and Ca(OH)2 Apexit/Sealapex Vivadent/Kerr
Glassionomer cement Ketac Endo/ Endion ESPE/Voco
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ROOTCANAL FILLING MATERIALS

• ADULT ENDODONTIC THERAPY

Composition Product name Company
Paraformaldehid N2 Universal Hager Werken
Cortikosteroid Endomethasone Pharma-Dental
Hexachlorofen, dichlorofen Diaket A ESPE

Mineral Trioxide Agregate ProRoot MTA Denstply
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GUTTAPERCHA

• Properties

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Thank you for your kind attention!