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Biocompatibility ( biomaterial/bioacceptance) - Being harmonious with life and not having toxic or injurious effects on biologic function. - Measured on the basis of: 1. Local cytotoxicity (pulp, and mucosal response) 2. Systemic responses 3. Allergenicity 4. carcinogenicity Requirements for biocompatibility of dental material 1. It should not be harmful to the pulp and soft tissues 2. It should not contain toxic diffusible substances that can be released and absorbed into the circulatory system to cause systemic response. 3. It should be free of potentially sensitizing agents that are likely to cause an allergic response. 4. It should have no carcinogenic potential Biomaterial- any substance other than a drug that can be used for any period as a part of a system that treats , augments, or replaces any tissue, organ or function of the body. Tests fo Evaluation of Biocompatibility 1. Group I:Primary Test – consists of cytotoxic evaluations ( Genotoxicity test) 2. Group II: Secondary Tests- (implantation tests)evaluated for its potential to create systemic toxicity, inhalation toxicity , skin irritation and sensitization. Irritation- is an inflammation brought about without intervention of an antibody or immune system. Sensitization- an inflammatory response requiring the pax of an antibody. Allergen a substance that is not primarily irritating on the first exposure but produces rxns more rapidly in animals of appropriate genetic constitution on subsequent exposure to similar conc. 3. Group III: Preclinical Tests- efficacy and usage test after it successfully passes the primary and secondary test. a. Pulp and Dentin Usage test b. Pulp capping and pulpotomy usage test c. Endodontic usage test Anatomy of the Tooth Allergic Responses to Dental Materials Allergic Contact Dermatitis - Most common occupational disease - Usually occurs where the body surface comes in direct contact with the allergen, eg. Allergy to latex products Allergic contact stomatitis - Most common adverse reaction to dental materials - Definitive diagnostic test is a patch test - Symp: hyperemia, edema, vesicle formation, & itching - Common allergens: chronium, cobalt mercury, eugenol, components of resin based materials, colophonium and formaldehyde - “Burning Mouth Syndrome” - Others, mouthwashes, dentrifices, toical medications like lozenges and cough drops - - The Mercury Controversy Minamata disaster of 1970. Minamata Bay, Japan Methylated mercury poisoning Less than 0.01% of Elemental mercury is absorbed with 8 to 10 amalgam restorations in the mouth. Elemental mercury poisoning- paresthesia of the extremities, lips, and tongue, ataxia( gait disturbance), concentric constriction of visual fields( tunnel vision) Micromercurialism hypersensitivity- extremely small amounts of mercury with the signs and symptoms of mercury poisoning( cutaneous patch test) Allergy to nickel Allergy to berryllium MINIMIZING DENTAL IATROGENESIS - Creation of side effects, problems, or complications resulting from treatment - RDT- 1mm or less all categories - PTI- the response values of pulp, - RDF- secondary dentin as a response of the pulp PULP RESPONSES Amalgam 2. Chemically cured resin composites 3. Visible light cured resin composites 4. Zinc phosphate cement 5. Glass ionomer cement 6. Resin – Based composite cements( dual cure) 7. Conditioning agents 8. Bonding agents Influence of patient on pulp response At age 55, the volume of tissue is about one fifth that at age 25 including the blood supply. 1. MICROLEAKAGE - Can be controlled but not completely eliminated DENTIN HYPERSENSITIVITY Factors to consider with DH 1. The age and sex of the patient 2. The age of the tooth 3. The amount of sclerosis present 4. The proximity of the pulp (RDT) 5. The presence or absence of CH liners 6. The depth of carious lesions versus the thickness of of RDF PULP CAPPING ENDODONTICS ANY QUESTIONS !!???