GOOD MORNING

1
BIOCOMPATIBILITY
OF DENTAL
MATERIALS

2
 contents
Introduction
Historical Background
Health Effects
Key Principles That Determine Adverse
Effects From Materials
Determination Of Biocompatibility
Strategies For Evaluating
Biocompatibility
Regulations And Standards

3
 contents
Biocompatibility Of Various Dental Materials
 Resin Based Composites
 Cements and Ceramics
 Dental Alloys
 Oral Hygiene Products
 Impression Materials
 Barrier Materials( Gloves & Mouth Masks)
 Methyl methacrylate
Diagnostic tests on patients
Conclusion
References

4
INTRODUCTION

5
 DEFINITIONS
It is the ability of a material to elicit
an appropriate biological response in a
given application in
the body.
WILLIAM D,F 1987
The term biocompatible is defined as
being harmonious with life and not
having toxic or injurious effects on
biologic function.
DORLAND’S ILLUSTRATED MEDICAL
DICTIONARY

6
HISTORICAL BACKGROUND
• Concept of ethical treatment of
patients extends back to the time of
Hippocrates (460 – 377 B. C.)

•Mid 1800:dentists tried new materials

for the first time by putting them into
patient’s mouth

•Concept of protecting the patient as a

research subject is only 30-40 Years
old.
7
HISTORICAL BACKGROUND

The current philosophy about

testing the biological properties of
dental materials in a systematic
way evolved in the 1960s as the
need to protect patients became
politically acute and as the number
of new materials increased.

8
 Adverse effects from dental
materials
0.1%
Among dental personnel 40- 50%

•Toxicity
•Inflammation
•Allergy
•Mutagenic &carcinogenic reactions

9
 TOXICITY

 Placement of a foreign material in the body carries

the possibility of toxicity

 Materials may be capable of releasing substances into

the patients body and the release of certain
substances in adequate can cause overt toxicity.

 Toxicity can be of 2 types

 Systemic toxicity
 local toxicity
10
 SYSTEMIC TOXICITY

ACUTE
SUBACUTE
CHRONIC
 Type 1: requires prolonged or repeated
administration
 Type 2: requires very few or one dose
but long lasting effect
Type 1 chronic toxicity is a possibility with
“Biomaterials”
Eg: metal ions released by gradual corrosion of
an implant

11
 LOCAL TOXICITY
Substances released from dental materials –cell metabolism-
Inflammation or necrosis
Accumulation of bacteria
Mechanical/physical irritation

Pulp necrosis after

application of resin
fillings

Inflammation of the gingiva

in contact with a porcelain-
fused-to-metal crown

12
 (Chronic local irritative
reaction) Exacerbation of a
Buccal mucosa lichen lesion in
contact with a corroded amalgam
restoration

Irritative lesion caused by

unintended prolonged exposure
to an enamel etchant(Acute
local irritative reaction)

13
 Inflammation
 Inflammatory response is complex but involves the activation of
host’s immune system to ward off some threat
 May result from toxicity or allergy and often it precedes toxicity.
 Edema, inflammatory cell infiltrate
 Current biocompatibility research …materials contribute to
inflammation even if no toxicity is evident.

14
Allergy

15
 ALLERGY
 Body specifically recognizes a material as foreign
& reacts disproportional to the amount of material

 Gell & Coomb’s classification of immune responses

 Type 1: Atopic or anaphylactic reaction
 Type 2: Cytotoxic hypersensitivity reaction
 Type 3: Immune complex disease
 Type 4: Delayed or cell mediated hypersensitivity
 Type 5: Stimulating antibody reaction
 Type 6: Antibody dependent, cell mediated Cytotoxic
reaction
16
 Type 1, 2, 3 – immediate. Eosinophils, Mast cells
& B lymphocytes.
 Type 4 – delayed. Monocytes & T cells
 Allergic response to a substance can be
triggered if the organism was previously
sensitized to this compound.
 Allergic reactions –dose independent,
disproportionate .
 Toxic / inflammatory reactions – dose
dependant, proportionate.

17
ALLERGIES
Dental materials ..
Type I (immediate reaction)
type IV (delayed reaction)

TYPE І AND TYPE ІV

Dose levels causing allergic
reactions are generally
significantly lower than those
causing toxic reactions.

18
 IMMEDIATE ALLERGIC
REACTIONS (IgE mediated)
An immediate allergic reaction occurs when an allergen
enters the circulation by ingestion or parenteral routes
,localizes in a target tissue (e.g. in the oral cavity), and
binds with IgE mast cell complexes, which release
histamine.
Oral vesiculo-ulcerative lesions
Urticaria
Angioedema
Anaphylactic shock 19
 ANGIOEDEMA

A diffuse swelling of the facial

tissues over a large area… single
swollen lip, the eyelids or the whole
face may be affected.

The tongue and floor of the mouth

may also be swollen.

Swelling of the upper lip

following contact with disposable
latex gloves worn by the dentist

20
 Contact Urticaria

A local immediate erythemal

or pruritic reaction at the
site of epidermal or mucosal
contact with the causative
agent.

Occupational exposure to
latex proteins in
disposable gloves

21
 DELAYED ALLERGIC
REACTIONS (Cell mediated)

Specific sensitized T
lymphocytes, which react with
the allergen and release
lymphokines, eliciting an
inflammatory reaction.

General allergic contact

Stomatitis

Local allergic contact

Stomatitis
22
 Local allergic contact reactions
Elicited by metals or acrylate used in dentures, prosthetic
framework, fillings, inlays, crowns or implants most often shows a sharp
delineation adjacent to or contacting the eliciting material

 The lesions are generally well defined and may be whitish or

Erythematous.

• Allergic contact dermatitis on the

fingertip of a dentist after contact
with resin-based composite

23
 DELAYED ALLERGIC
REACTIONS (Cell mediated)

White contact lesion

adjacent to corroded
amalgam restoration

Local allergic contact

Stomatitis

24
 DELAYED ALLERGIC
REACTIONS (Cell mediated)

Erythematous contact
lesion adjacent to 23
and 24

Local allergic contact

Stomatitis

25
OTHER REACTIONS
Mutagenicity

Alteration in base pair sequence (mutation)

2 types
Alteration in cellular process that
maintain DNA integrity
Direct interaction

Can occur from radiations, chemicals,

errors in DNA replication process

 Nickel, copper, beryllium, Resin based

materials

26
Carcinogenic response
 Currently no dental material has
been shown to be carcinogenic for
dental applications in patients

 However, carcinogenesis is often

exceedingly difficult to prove or
disprove conclusively

27
KEY PRINCIPLES THAT
DETERMINE ADVERSE EFFECTS
FROM MATERIALS
METAL Composition
CORROSION Biological environment
OR MATERIAL
Salivary Esterases- dental resins
DEGRADATION
Ingestion of acidic substances-
corrosion of alloys and ceramics

SURFACE Positive effect - Ti alloys

CHARACTERISTICS Negative effect – rough surface
Dental casting – Corrosion
70wt% gold Promotes adherence of bacteria
95% gold at its surface Periodontal inflammation
Decay in teeth

28
 Concept of
Immunotoxicity

29
 Concept of Immunotoxicity
“small alteration in the cells of immune systems
by materials can have significant biological
consequences “

 Eg:
Hg ions increase the Glutathione but Pd ions
decreases Glutathione content of Monocytes
HEMA may change the ability of Monocytes to
direct an immune response once challenged by
plaque or others agents

30
 EVALUATION OF
BIOCOMPATIBILITY

Alloy

Pulpal compatibility
Allergic potency

31
BASIC TYPE OF TESTS

In Vitro Test

In Animal Test

Usage Test/
Clinical trials

32
 IN VITRO TEST
• Test tube, cell culture dish, flask,or
other container
• Material or an extract of a material is
placed into contact with some biological
system
Eg:Mammalian cells, cellular organelles,
tissues, bacteria, or some sort of enzyme
• Direct or indirect

33
Types of in vitro tests

Cytotoxicity or
cell growth

Metabolic and
other cell function

Effect on the
genetic material

34
 Tests for Cytotoxicity
Cells are placed in a well of a cell culture dish where
they attach… material is then placed…

Not cytotoxic, the cells will proliferate with time.

Cytotoxic, the cells may stop growing

If the material is a solid, then the density (number of

cells per unit area) of cells may be assessed at different
distances from the material.

35
 Tests for cell metabolism or cell function:-

• MTT test.

• Measures the activity of cellular

dehydrogenases, which convert a chemical
called MTT, via several reducing agents to a
blue insoluble formazan compound.

• If the dehydrogenases are not active .. the

formazan will not form. the formazan can be
localized around the test sample by light or
electron microscopy

36
 Effect on the genetic material
• Ame’s test:
• Mutant salmonella typhimurium
…exogenous Histidine. Native stocks of
bacteria do not require exogenous
Histidine.

• Exclusion of Histidine from the culture

medium allows a material to be tested
for its ability to convert the mutant
strain to a native strain.

• Chemicals that significantly increase

the frequency of reversion back to the
native state …being carcinogenic in
mammals. 37
 Dentin barrier tests
• A dentin disk is placed between
the test material and the target
cells

• Pulpal reaction to znoe is

relatively mild as compared with
the same material in direct
contact with cells in vitro assays.

38
 IN VITRO TEST
ADVANTAGES

•Quick to perform
•Least expensive
•Can be standardized
•Large scale screening
•Good experimental control

39
 IN VITRO TEST
DISADVANTAGES

•Questionable relevance to
the final in vivo use of the
material
•Lack of inflammatory or
other tissue protective
mechanisms in the in vitro
environment

40
 IN ANIMAL TEST
Mammals

• Place a material into an intact organism of some type

• These tests expose the animal without regard to the

material final use.

41
 ANIMAL TEST

• Mice,rats,hamsters,ferrets or guinea pigs

• Types:-
• Mucous membrane irritation test
• Skin- sensitization test
• Implantation test

42
 Mucous membrane irritation test
• Placing the test materials and
positive and negative controls into
contact with rabbit oral tissue.

• After several weeks of contact, the

controls and test site are examined,
and the gross tissue reactions in the
living animals are recorded and
photographed.

• The animals are then sacrificed and

biopsy specimens are prepared for
histological evaluation of
inflammatory changes.

43
 Skin- sensitization test

• Guinea pigs, the materials are

injected intradermally to test for
development of skin
hypersensitivity reactions.

• The injection is followed by

adhesive patches containing the
test substance.

• If hypersensitivity developed from

initial injection, the patch will elicit
an inflammatory response.

44
 Implantation tests
• Materials are implanted s.c, i.m or in
the bone of an experimental animals

• B/w 1 week and several months, the

adjacent tissue is investigated macro
and microscopically.

• After a short implantation time (1-2

weeks), degrees of inflammation
surrounding the implant will primarily
assessed.

45
 IN ANIMAL TEST
ADVANTAGES

•Allows complex systemic interactions

•Response more comprehensive than in vitro
test
•More relevant than in vitro test

46
 IN ANIMAL TEST
DISADVANTAGES

•Questionable relevance to the

final in vivo use of the material
•Expensive
•Time consuming
•Legal/ethical concerns
•Difficult to control
•Difficult to interpret and quantify

47
 IN USAGE TEST
LARGER ANIMALS or IN HUMAN VOLUNTEERS

Requires that material be placed in a situation identical to

its intended clinical use
GOLD STANDARD

•Mucosa and gingival usage test

•Intraosseous implant test

48
 Mucosa and Gingival usage tests
• Materials are placed with subgingival
extensions.

• Effects on gingival tissues …at 7 days &

after 30 days.

• Disadvantages:
– preexisting inflammation in the gingival
tissue
– surface roughness of the restorative
material
– overcontouring and undercontouring of
the restoration.

49
 Intraosseous implant test
• Materials used for dental implants are
inserted into the jaw of the test animals.

• Primates, dogs, guinea pigs and rats.

• Histologically, the tissue in contact with the

implant assessed.

• Available data from these animal studies

show that implants based on titanium or
ceramics are generally well tolerated by
the surrounding tissue.

50
 IN USAGE TEST
ADVANTAGES
• Relevance to the use of
material is assured

DISADVANTAGES
•Very Expensive
•VeryTime consuming
•Major Legal/ethical concerns
•Can be Difficult to control
•Difficult to interpret and quantify

51
 STRATEGIES FOR EVALUATING
BIOCOMPATIBILITY
Progress
of Usage
Usage
testing
test
test

LINEAR PARADIGMS Secondary

Secondary test
test

•Most efficient
•Cost effective Primary test
Primary test

Number of tests

52
 Primary tests
• Performed initially in testing of new material

• Invitro in nature but may include some animal test

 To measure
• Cytotoxicity,
• mutagenecity,
• systemic toxicity

53
 Secondary tests
• Usually conducted in animals
 To measure
• Chronic toxicity,Inflammation & Allergy
• Sophisticated invitro tests like tests for
estrogenecity,surface effects & osteoinduction are
secondary in nature.

• Usage tests
• Material is tested in clinically relevant situation

54
• Mjor et al (1977)
compared this linear paradigm used in
dentistry..concluded .. Invitro ,animal tests need not
necessarily predict the results of usage tests
• Poor correlation among these tests.
• Relies heavily on the accuracy of the primary tests
• Too severe – good materials will be screened out
• Too insensitive – wasting time, money and placing
animals or humans at Unnecessary risk

55
Newer schemes for the
progression

• All three tests

U
Progress
may be done
of initially, but as
testing
S the testing
P
progresses, the
usage tests
predominate.

ATERNATIVE PARADIGMS
56
 • Common progression is
from primary to
Usage secondary to usage tests,
• But any test may be
performed at any time in
Primary Secondary the development of a
material, depending on
problems that are
encountered.

57
 REGULATIONS & STANDARDS
• Acc. To Medical Device Directive(MDD) : -
A medical device is applied as a device used for
diagnosis, prevention, monitoring, treatment or
alleviation of disease.
• Does not achieve its principal intended action in or on
the humans by Pharmacological, Immunological or
metabolic means.
• E.g. Dental material

• European Economic area - MDD

• United States – FDA

58
• A multiplicity of laws,
standards and Laws
recommendations regulate Standards
Recommendations
the marketing of medical
devices, generating the
impression that dentist can
exclusively rely on them( eg.
CE Labeling).

59
 REGULATIONS & STANDARDS
• Safety data sheets.
• safety labels on the
wrappings
.

60
REGULATIONS & STANDARDS
•Horizontal Standards
(valid for all medical
devices)
•Semihorizontal
Standards (valid for
groups of products
such as Dental
materials)
•Vertical Standards
( valid for individual
materials such as
amalgam)

61
• ANSI/ADA Document 41
• Biological testing of Dental Materials
• 1972, updated in 1982 to include tests for Mutagenicity.
• This specification uses the linear paradigm for materials
screening and divides testing into initial, secondary and
usage tests.

• ISO standard 10993

• Biological evaluation of medical devices
• International standard
• Not restricted to dental materials (horizontal standard)

62
Biocompatibility Of Various
Dental Materials

63
 RESIN BASED COMPOSITES
• Anterior and posterior filling materials
• Luting composites(eg for luting ceramic & indirect
composite restorations and crown build ups)
• Bonding of brackets and orthodontic bands.
• Temporary crowns & bridges
• Pit & fissure sealants
• Auxiliary materials -acids and adhesives.

64
 Resin based materials :

 MMA, HEMA, TEGDMA,

EGDMA,Formaldehyde &
Glutaraldehyde
silicon, Boron, sodium and Barium

 Light cured < cytotoxic than

chemically cured

 Pulpal reaction diminishes after 5 –

8 weeks

 Protective liner or bonding agent

minimizes Pulpal reaction

65
Extraoral allergic reactions
(type I) after application of a
pit and fissure sealant

Allergic contact dermatitis of a

dentist after contact with resin-
based composites

66
Chemical burn after
inadvertent contact of
phosphoric acid with
gingiva

Gingivitis adjacent to
a cervical composite
resin filling

67
 Light curing units
• Hazardous to eyes
• Afterimages( Reversible)
• Photochemical damages(loss of
acuity)(irreversible)
• Protective glasses/ protective shields

68
 Zinc Phosphate cement
pH - 2 at 2mints => 5.5 after 24
hours
No systemic or allergic reactions
Cytotoxic – immediately
When placed in VITAL TEETH?
Inclusion of Ca- OH to the
powder or lowering the
concentration of phosphoric acid

69
Zinc phosphate cement
that was left in the sulcus
after cementation results
in periodontal destruction.

70
 Glass Ionomer Cements
 Luting agent & restorative
material

 Histological studies in
usage test shows that any
inflammatory infiltrate to
ionomer is minimal or
absent after 1 month.

71
 Calcium Hydroxide Cement
Suspension form Resin containing

Highly cytotoxic Mild to moderate cytotoxic

Necrosis 1mm or > No necrotic zone

shortly
Dentine bridge formation Dentine bridge formation
is quick

72
 Zinc Oxide Eugenol Cement
Max Eugenol release- within first 5
hour(4-5%)
Antimicrobial properties against a
great variety of bacteria

Reaction of the gingiva after

temporary cementation of a crown with
a zinc oxide and eugenol cement.

73
 Precautions during cementation

 Apply petroleum jelly to the surrounding soft tissues

 Clean the excess cement after luting the prosthesis

 Any residues of cement left in the gingival sulcus will

lead to inflammation

74
 DENTAL CERAMICS
Biocompatible,,Few are Cytotoxic - in vitro

Auxiliary materials
HF acid
If HF comes into contact with skin or mucosa, it may not cause
immediate chemical burn, but within 24-48h, deep tissue necrosis
occurs.
2%HF- erosion of the cornea.

1.23% APF gels may roughen the ceramic surfaces, subsequently

increasing plaque accumulation.

Occupational exposure in labs

Radioactivity of Zirconium Oxide > Al2O3 & SiO2

75
Casting alloys
76
 DENTAL ALLOYS
25 elements
Phase Structure – corrosion properties & biocompatibility
B.C- Released elements, quantities, duration of tissue exposure
Ni & Cu – gingivitis
High Gold & Gold alloys – discolorations & hyperplasia of gingiva
 Thermal treatment ( Ceramic alloys)- cytotoxic
Incomplete removal of oxide layers-gingivitis

77
Metal ions acts as Haptens + resident molecules =
complex (foreign)
Cross reactivity – Pd & Ni allergy
Medical history-Allergy to Jewelry, watches, metal
attachments to clothing, etc.

78
gingivitis due to the PFM
crowns;

after removal of the crowns

and seating of
temporary resin crowns

79
Gold coating of nickel-
based and cobalt-based
alloys.

Pronounced redness of the

palate beneath the denture
base.

80
Perioral allergic reaction
after insertion of nickel-
containing orthodontic wires
(CuNiTi)

Lichenoid reaction of
the mucosa contacting an
alloy

81
Pronounced gingivitis after
seating of ceramic crowns,
despite good oral hygiene

Dental lab –Inhaled beryllium –

berylliosis.

82
 DIAGNOSTIC TESTS ON
PATIENT
Allergy tests:

In patch test: - ( Type IV)

adhesive tapes containing the potential allergens are adhered to
the clinically sound skin of the patient’s back.
During the following days, after the tape has been removed, the
skin is evaluated for test reactions & after 2-3 days

In prick test:-(Type I)

 the allergen is applied as a drop to the skin and then the skin is
pricked through the drop. After 5-30 minutes, the skin reaction is
assessed.

83
 Analysis of Intraoral alloys
• CHIP TEST
• To know the composition of alloy
a) Collection of alloy particles/chips.
b) Alloy chips attached to self-
adhesive graphite disk.
C) Scanning electron microscopic
image of an alloy chip.
d) Results of energy dispersive x-ray
analysis; 84
 Analysis of metals in saliva and
biopsies

• A defined amount of morning saliva ( before any food or drink

intake or oral hygiene measures) is collected and after chemical
pulping, is analyzed using atomic absorption spectrometry(AAS).

• Biopsies, from the gingiva were also used to determine the

metal content.

85
 ORAL HYGIENE
PRODUCTS
Toothpastes & Mouthwashes

 Alcohol
Fluorides
Abrasives
Chlorhexidine
.Allergens are
Flavoring Agents – cinnamon, peppermint, spearmint
Chlorhexidine
Others – acetamide, azulene, benzoates, Choroacetamide, propolis.

86
 ORAL HYGIENE
PRODUCTS
Mechanical abrasion of
tooth substance

Allergic contact cheilitis

from spearmint oil in a
toothpaste

87
 Bleaching agents :
 Catabolism of H2O2 => O2 & water
 Venous embolization
 Cerebral Infarction – 35% H2O2
 Dental Hypersensitivity
 In-Vitro – traverses the dentine & in sufficient conc. can
be cytotoxic

88
 TOOTH BLEACHING
AGENTS

Skin lesions on a dentist’s

fingertips, caused by unintentional
contact a bleaching agent in a
dental office

89
Impression materials

90
 Impression materials
Silicones – A & C
Polyether
Polysulphides
Hydrocolloids
Alginate
ZnOE

Additional silicones , hydrocolloids and alginate –

nontoxic
 least biocompatibility applies to condensational
silicones

91
 Distinct local toxic effects- mixing of putty
materials
 Latex-may impair the polymerization
 Eyes must be protected by appropriate
glasses when liquid catalysts are used
 Periodontal sulcus has to be carefully
monitored for remnants of impression
materials

92
Fatal Anaphylactic Shock Due to
a Dental Impression Material

Gangemi et al
• Department of Human Pathology.
University of Messina. Italy .

• Int J Prosthodont 2009;22:33-34

93
• A 75-year-old man with diabetes, cardiopathy, and chronic
bronchitis underwent a dental impression for a new denture

• Immediately after the use of an impression paste, the man

presented with dyspnea and tongue edema.

• Referred to the closest hospital, a severe edema of the

tongue, epiglottis, end glosso-epiglottic region was observed.

• Treated with 4 mg of iv betamethasone and after some

improvement in swelling, he continued aerosol therapy with
betamethasone and oxygen.

94
 One hour later, the patient suddenly
worsened. He was again treated with 4 mg
of iv betamethasone and underwent a
tracheotomy.

 Ten minutes later, despite a CPR attempt,

the patient died. He had no prior history of
atopy or adverse drug reactions.

Fig 1 Edema of the tongue

95
 Discussion
• The cause of death was heart
failure, an acute myocardial
insufficiency with the involvement
of several other pathologic factors.

• The autopsy showed cardiac and

bronchial findings to be comorbid
diseases; the most common
pathologies found in patient
undergoing autopsy deceased due
to anaphylaxis.

96
• The safety data sheet reports that the
product has not had any hazardous reactions,
nor does it have any hazardous decomposition
products

• Among the Kromopan components, only

phenolphthalein has been reported as causing
toxic epidermal necrolysis and fixed drug
eruption

97
Latex

98
 BARRIER MATERIALS
 Latex :
 6% to 7% of surgical personnel may be allergic
 42% adverse reactions to occupational materials
 Hypersensitivity may be due to true latex allergy or
reaction to accelerator & antioxidants
White, milky sap

Addition of ammonia

Hydrolyses & degrades the sap proteins to produce

allergens

99
Liquid vulcanization solid
latex sulphur + heat rubber

 Soaked in hot water leaches out allergens

 Allergenicity depends on collecting,
preservation & processing

100
 BARRIER MATERIALS
•Contact urticaria following
occupational exposure to
latex proteins in disposable
gloves

•severe irritative hand

dermatitis (non allergic)
caused by frequent hand
washing and wearing of
disposable gloves

101
 POLYMETHYLMETHACRYLATE
RESINS
 a) Denture base materials
 Methacrylates -Greatest potential
for hyper sensitization
 Acrylic & diacrylic monomers, curing
agents, antioxidants, amines,
formaldehydes
 For the patients most of these
materials have been reacted in
polymerization and thus less prone

102
 True allergy of oral mucosa to denture base
material is very rare
 Residual monomer (methyl methacrylate) is
believed to be responsible for allergic reactions
in susceptible patients
 Allergic acrylic stomatitis – diffuse erythema,
edema & occasionally small vesicles and erosions
 Heat cured is better

103
 Dentist suffering from an
allergy to methyl
methacrylate contact
dermatitis

 Pronounced inflammation
of the palatal mucosa
beneath a polymethyl
methacrylate denture
with papillary hyperplasia

104
 Soft denture liners &
adhesives
 Release of plasticizers
 Extremely cytotoxic
 Effects are masked by
the inflammation
 Denture adhesives
show severe cytotoxic
reactions In-Vitro
Large amount of
formaldehyde
Allowed significant
microbial growth
105
 Denture cleansers
Used to cleanse the prosthesis
 Eg : Hypochlorite, mild acids, etc.
Biocompatible & cause no harm to the
patient

106
 Artificial teeth

Acrylic & Porcelain

teeth
Acrylic teeth is more
resilient & preferred
in poor ridges

107
Implants

108
 Reaction of bone & soft tissues
to implant material
 Materials – Ceramics, Metals, & Polymers

 a) Reaction to ceramic implant material

 Very low toxic effects.
 Oxidized state, corrosion resistant

 b) Hydroxyapatite
 Relatively non resorbable form of calcium phosphate
 Coating material & ridge augmentation material

 c) Beta -Tricalcium phosphate

 Another form of calcium phosphate, has been used in situations
where resorption of the material is desirable

109
 d) Reaction to pure metals & alloys
 ‘Metal’ oldest type of oral implant material
 Shares the quality of ‘strength’
 Initially selected on the basis of the ‘Ease of
fabrication’
 Stainless Steel, Chromium-Cobalt-
Molybdenum, Titanium and its alloys
 Most commonly used is Titanium
 Titanium’s Biocompatibility is associated with
its fast oxidizing capacity.
 Corrosion resistant & allows
Osseointegration

110
 Soft tissue :
 Epithelium forms a
bond with implant
similar to that of tooth
 C.T apparently does not
bond to the titanium,
but forms a tight seal
that seems to limits
ingress of bacteria & its
products

111
 CONCLUSION
• It is often difficult for clinicians to evaluate the
biological safety of new materials. However,
with thorough knowledge of biocompatibility
issues and some common sense, clinician can
make reasonable judgments’ about biological
safety.

112
 REFERENCES
Text Books
 Biocompatibility of dental materials –
Gottfried Schmalz & Dorthe Arenholt –
Bindslev
Restorative dental materials (11
edition) – G. Craig & John H. Powers
PHILLIPs’ Science of dental material
(11 edition)

World wide web

www. doctorsguide.org
www.mercurypoisoned .com
Google search

113
 Thank you

“At times we have many

options but we have to
choose the best among
them”
114