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SEMMELWEIS UNIVERSITY
BUDAPEST
Department of Pedododntics
and Orthodontics
FILLING MATERIALS
in Pedodontics
Dr. Rózsa Noémi
Dr. Déri Katalin
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
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
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
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
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
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
• Direct pulp capping –in primary
dentition may cause chronic pulpitis
MINERAL TRIOXIDE AGGREGATE
MTA
Torabinejad et al. - 1995
1993 – lateral root perforation
retrograde root filling,
direct pulp capping,
bifurcation perforation,
• tricalcium-silicate
apexification.
• dicalcium-silicate
MTA
pH = 12,5 ~ Ca(OH)2
• tricalcium-aluminate
• calciumsulfat-dihidrate
• bismutoxid
• tetracalcium-aluminoferrit
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 > 1 mm
• fissure sealing
• prosthetic preparation
• temporary filling
• definitive filling - primary molars
Glassionomer Cement - GIC
Type
Advantage
Disadvantage
Indication
Traditional
self curing
F- release
No Adhesive technique
aesthetics
Powder/liquid proportions
Mechanical properties
Primary molars
Colour (pink)
Long-term water absorption
FS
Cervical erosions
TF
insensitive to moisture
aesthetics
1% ~ polym. shrinkage
allergy
Pulpal lesions
underfilling
prosthetic
Small occlusal
cavity
F- release
Water absorption, water
release
Exact dosage
mechanical properties
aesthetics
Primary molars
TF, underfilling
prosthetics
traditional GIC
aesthetics, ↓F-
Primary molars
Dual setting
Resin reinforced
GIC
Hard, fast setting
CERMET
(Metal reinforced GIC)
Fissure sealing
GIC
CERMET CEMENT
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: 2’30”
Light-curing: 2O”
GC Fuji Triage
GC Fuji Triage or VII
• Additional indications
Sensitivity
Intermediate
endodontic
sealing
Intermediate
restoration
Root
surface
protection
GC Fuji II LC
Amalgam
•
Quantity:
•
Cu contents:
•
•
•
low: 2-5% - conventional ~
high: 12-30% - non-gamma-2 ~
Form: < 20-25 µm
–
–
–
–
lathe-cut plate
spherical
Irregular form
mixed
Amalgam
Conventional amalgam
Ag3Sn
γphase
+ Hg →
Ag2Hg3 + Sn8Hg + ≈Ag3Sn
γ1phase
γ2phase
γ-phase
High Copper amalgam
Ag3Sn + Cu3Sn + Hg → Ag2Hg3 +
γphase
γ1phase
Cu6Sn5
η’-phase
+
≈Ag3Sn
γ-phase
• corrosion
• mercuroscopic expansion
• Hg
Primary Dentition - Amalgam
Amalgam
• amalgam – dental unit water
pipe
• pregnancy
• children
• biological dentistry
(natural dentistry)
Composite filling materials
= min. two, chemically different material and one phase
3D combination
LUTZ et al.
Filler type
Conventional composite
CC
macrofiller
Hibrid composite HC
minifiller,
midifiller,
nanofiller
Particule
10 – 100µm
Properties
•↓polym. shrinkage
• good physical ~
• difficult polishing
0,1 – 1 µm
• ↑ polym. shrinkage
1 – 10 µm
• good physical and
0,005 – 0,01 µm optical ~
Homogenic microfilled
composite HMC
microfiller
0,01 – 0,1 µm
Nonhomogenic
microfilled, heterogenic
composite IMC
microfillercomplex
microfiller
+
100 – 200 µm
• resist. abrasion
• good polishing
•↑ polym. shrinkage
• good marginal
sealing
• aesthetics
• fracture
Composit Filling Materials
Special composites
Filler type
Ormocers
Organically modified
ceramic
„cross linked”
polysiloxan in the
organic matrix
Insert - Glass for
Molars
megafiller
0,5 -2,0 mm
Modified
heterogen/homogen
composites
modified filler:
fibre, crystal
• better physical ~
Flowable composites
Flow
HK - ↓ filler%
• fissure sealant
• base for composites
Condensing compozites
↑ filler%
> 80%
Properties
•↓polym. shrinkage
• good resistance to abrasion
• difficult to polish
• occlusal contact
• difficult to apply
• special polym. technique
• molars
• ↓ aesthetic ~
• ↑ viscosity ≈ HK
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
→ FLight curing → filling material
Self curing → luting cement
Twinky Star
Light curing coloured compomer
Primary dentition
Alternative ~ amalgam
Radiopaque
FCompliance
Twinky Star
Oba AA, Sönmez IS, Sari Ş.
Clinical Evaluation of a Colored Compomer
In Primary Molars
Med Princ Pract 2009; 18:31-34
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
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; 23:1044-1048.
Jafaranta B, Soderholm K-J, Guelmann M. Light
penetration and bond strength of MagicfilTM to
primary molars. Baltimor Convention Center 2005.
blue < white < purple < yellow
Stainless steelcrowns
• ring
• primary molars;
• occlusal rehabilitation;
• long-term solution;
• time-consuming preparation;
• cementation.
Stainless steel crowns
• Tooth preparation and
crown adaptation
Stainless steel crowns
• contact point
preparation
• marginal finishing of the
crown
Aesthetic crowns
• PedoPearlsTM (1980)
• Celluloid crown +
composit
Whiter Biter Crown
II
• „strip crown”
• NuSmileR
• „Pedo Jacket”
• white veneers
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; 33:537-541.
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
Aesthetic crowns
• NuSmileR
Composite filling
Source: Th. Croll. Restoring four primary incisors using NuSmile Primary Crowns.
Paediatric Restoration, 2007 Dental products Report Europe
Aesthetic crowns
• NuSmileR
• 25-30%
Source: Th. Croll. Restoring four primary incisors using NuSmile Primary Crowns.
Paediatric Restoration, 2007 Dental Products Report Europe
FISSURESEALANT
MATERIALS
• Bis-GMA
• GIC
FISSURESEALANT
MATERIALS
White/
opaque
Toothcoloured
Clear
Coloured
Colourchannging
Chroma
Bis-GMA – adverse effects
BISPHENOL-A
METACRYLIC
ACID
• LOCAL
- CARIES INCIPIENS sealing;
- pulp – phosphoric acid;
- gingival irritation - fluoride;
• SYSTEMIC
- allergy, anaphylactic reaction ,asthma;
- carcinogenic, teratogenic
CleanProTM
„Colour changing”
Fissure sealant
Helioseal
Clear Chroma
3M - ESPE
IVOCLARVIVADENT
CleanProTM – „No rinse sealant technique”
• Self etching: 15” - AdperTM PromptTM L-PopTM;
• No need for rinse;
• Only for occlusal surfaces;
• self curing
fissure sealer
EMBRACE - WetBond
• Insensitive to moisture
• No bond necessary.
Pulpdent,J.P.O’Donnell
InTen-S
• Light curing composite
• ↓ polym. shrinkage: 1,6%;
• Cavity preparation I – V, FS, primary dentition,
ceramic veneers reparation
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.
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%.
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
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
Glassionomer cement
Ketac Endo/ Endion ESPE/Voco
Vivadent/Kerr
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
GUTTAPERCHA
• Properties:
• less solubility;
• good handling;
• no tissue irritation;
• no deformation;
• solubility in organic solvents:
xylol, chloroform, eucalypt;
• X-ray opacity;
• biological neutrality;
• easy to remove.
• deformation under pressure: easy to
press through the apex;
• not rigid enough: difficult to apply in
narrow root canals;
• sealer application for wall-coating.
Thank you for your kind
attention!