SEMMELWEIS UNIVERSITY BUDAPEST Department of Pedododntics and Orthodontics

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 – 1 mm: Ca(OH)2, GIC • Base – 1 -2 mm: 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 – 1 mm: pulplesion, under amalgam - ↓ toxicity • Direct pulp capping –in primary dentition may cause chronic pulpitis

MINERAL TRIOXIDE AGGREGATE MTA 1993 – lateral root perforation Torabinejad et al. - 1995 retrograde root filling, direct pulp capping, bifurcation perforation, apexification. • tricalcium-silicate • dicalcium-silicate MTA p. H = 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-, Al 3+, Sr 2+ 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: 2 O”

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 Ag 3 Sn γphase + Hg → Ag 2 Hg 3 + Sn 8 Hg + ≈Ag 3 Sn γ 2 - γ 1 -phase γ-phase High Copper amalgam Ag 3 Sn + Cu 3 Sn + Hg → Ag 2 Hg 3 + γphase γ 1 phase Cu 6 Sn 5 η’-phase + ≈Ag 3 Sn 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 3 D combination LUTZ et al. Filler type Particule Properties • ↓polym. shrinkage • good physical ~ • difficult polishing Conventional composite CC macrofiller Hibrid composite HC minifiller, midifiller, nanofiller 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 • resist. abrasion • good polishing • ↑ polym. shrinkage Nonhomogenic microfilled, heterogenic composite IMC microfillercomplex microfiller + 100 – 200 µm • good marginal sealing • aesthetics • fracture 10 – 100µm

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

Magic. Fil. TM Coloured compomer Dual setting Insensitive to moisture F- , Zn 2+ → bactericidal Setting: 40” → 4’ Croll TP. Magic. Fil: 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 Magicfil. TM 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 • Pedo. Pearls. TM (1980) • Celluloid crown + composit Whiter Biter Crown II • „strip crown” • Nu. Smile. R • „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 • Pedo. Pearls (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 • Nu. Smile. R Composite filling Source: Th. Croll. Restoring four primary incisors using Nu. Smile Primary Crowns. Paediatric Restoration, 2007 Dental products Report Europe

Aesthetic crowns • Nu. Smile. R • 25 -30% Source: Th. Croll. Restoring four primary incisors using Nu. Smile 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

Clean. Pro. TM „Colour changing” Fissure sealant Helioseal Clear Chroma 3 M - ESPE IVOCLARVIVADENT

Clean. Pro. TM – „No rinse sealant technique” • • • Self etching: 15” - Adper. TM Prompt. TM L-Pop. TM; No need for rinse; Only for occlusal surfaces; • self curing fissure sealer

EMBRACE - Wet. Bond • Insensitive to moisture • No bond necessary. Pulpdent, J. P. O’Donnell

In. Ten-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 Fe 2(SO 4)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 AH 26, AH 26 Plus Dentsply De. Trey Metacrylate Polyhydroxi-metilmetacrylate 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 N 2 Universal Hager& Werken Cortikosteroid Endomethasone Pharma-Dental Hexachlorofen, dichlorofen Diaket A ESPE Mineral Trioxide Agregate Pro. Root 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!