Dental Applications
Dental Applications
Dental Applications
DENTAL APPLICATIONS
Introduction
The dental industry has taken great advantage of polymer science to design ma-
terials. Materials used in the oral cavity or external prostheses have very specific
requirements, ie, these materials must have physical, chemical, biological, and
aesthetic requirements, not always fulfilled by currently available materials. A
host of requirements must often be met, including adequate strength, resilience,
wear or abrasion resistance, dimensional stability for both fabrication and use,
translucency or transparency to provide a match of the natural tissue replaced,
good color stability, resistance to the oral environment, show tissue tolerance and
low toxicity, and exhibit ease of fabrication into a needed dental device. Since
few resins fulfill all the mentioned requirements, the search for improved dental
materials has been limited to a few classes of polymeric materials. The various
types of monomers and polymers used in dentistry are discussed, along with brief
attention given to new areas of promise for preparing better materials.
The largest volume of polymeric materials used in dentistry is in prosthetic
applications. Polymeric materials are also important in operative dentistry, being
used to produce composite resins, dental cements, adhesives, cavity liners, and as
a protective sealant for pits and fissures. Elastomers are employed as impression
materials. Resilient prosthetic devices are often fabricated to restore external soft-
tissue defects. Mouth protectors are fabricated to prevent injury to teeth, as well as
prevent head and neck injuries. Other polymer applications include fabricating
patterns for metal castings and partial denture frameworks, impression trays,
orthodontic and periodontal devices, space maintainers, bite plates, cleft palate
obdurators, and oral implants. Polymeric materials may also be used to fabricate
an artificial tongue, when disease results in its loss.
Encyclopedia of Polymer Science and Technology. Copyright John Wiley & Sons, Inc. All rights reserved.
172 DENTAL APPLICATIONS Vol. 2
The discovery of vulcanized rubber in 1839 gave rise to the first polymeric
dentures, followed by celluloid dentures about 1870, and subsequent use of vinyl
chloride copolymers, phenol–formaldehyde resins, and polystyrene. Acrylic-based
resins gained rapid acceptance after 1937, and are being greatly used today. Their
main disadvantages are related to shrinkage because of the free-radical polymer-
ization of methyl methacrylate, poor abrasion resistance, and fracture toughness.
Other polymers, such as epoxy resins, polystyrene, polyesters, polycarbonates,
polysulfones, vinyls, silicones, polysulfides, and polyethers, have been explored or
used to some degree.
The various dental polymers discussed in this article include impression
materials, dentures and denture liners, artificial teeth, crown and bridge mate-
rials, mouth protectors, maxillofacial materials, restoratives (consisting of glass
polyalkenoates or glass-ionomers and composites), adhesives, and sealants. Spec-
ifications and standards for dental materials are also briefly mentioned in the
text.
Impression/Duplicating Materials
Impressions must accurately show the dimensions, surface detail, and relation-
ship of teeth and soft oral tissues. Materials used to accomplish this task include
rigid gels of the reversible hydrogen-bonding type, irreversible alginate hydrocol-
loids, and elastomers such as silicones, polysulfides, and polyethers. Duplicates
of original casts, used to fabricate partial or complete dentures, are made from
duplicating materials.
Agar (Reversible Hydrocolloids). Agar, a galactose sulfate or muco-
polysaccharide (sulfonic acid ester of a galactan complex), is a long-chain polymer
having a molecular weight of about 150,000. The material forms a colloid with
water, with the solutions being liquid at ≥70◦ C and setting to a gel at 30–50◦ C.
Strong hydrogen bonding causes the molecule to form a helical structure, which
uncoils on heating. On cooling, the gel forms and reproduces the shape of the
oral tissues. These materials can be used several times, but prolonged heating
causes degradation. While agar is the main constituent, it is by no means the
main constitutent by weight. For example, a typical formulation consists of about
85.5% water, 12.5% agar, 1.7% potassium sulfate, 0.1% alkyl benzoate, and trace
amount of pigments. Fillers, such as zinc oxide and a hard wax or clay, are of-
ten used to modify the formulations. Borax or calcium metaborate may be used to
control the pH, increase viscosity, toughness, and resiliency. These materials were
developed to make accurate impressions, even of undercut areas. The agar used
in duplicating uses has a composition similar to the agar impression material, but
with a higher water content. ANSI/ADA Specifications No. 11 (1997) applies to
agar-based impression materials.
Alginates (Irreversible Hydrocolloids). The reactive component in
these materials is the sodium or potassium salt of anhydro-o-D-mannuronic acid
(alginic acid), isolated from brown seaweed (algae). A typical formulation consists
of about 18% sodium or potassium alginate, 14% calcium sulfate dihydrate, 2%
sodium phosphate, 10% potassium sulfate, 56% diatomaceous earth filler, and 4%
sodium silicofluoride. When mixed with controlled amounts of water, the soluble
Vol. 2 DENTAL APPLICATIONS 173
containing a low molecular weight silicone having terminal vinyl groups (Fig. 3)
and reinforcing filler and the other paste consisting of the hydrogen-terminated
silanol oligomer, filler, and chloroplatinic acid catalyst. Mixing the pastes gives
a cross-linked elastomer. No volatiles are given off during polymerization—a
definite advantage—compared to the condensation type, which eliminates ethyl
alcohol.
The condensation-type silicone impression materials are based on hydroxyl-
terminated poly(dimethylsiloxane), ie, viscous liquids of structure (Fig. 4). Col-
loidal silica or micronized metal oxides, having 5–10 µm particle size, are added
to prepare a paste which is cross-linked with an alkyl silicate containing 50%
ethoxy groups, such as tetraethyl orthosilicate (TEOS). Organic tin activators,
such as stannous octoate or dibutyltin dilaurate (2), are used at the 1–2% level.
The chief uses of silicone impression materials are for crown and fixed partial
dentures. These systems may be used in a wide range of impression techniques.
They are relatively easy to mix, producing high tensile strength materials having
good elastic properties, along with permanent-set values of about 1% at 40% strain.
But, they tear at relatively low extension.
Communicable diseases have caused concern in handling of impression ma-
terials, meaning impressions are not generally accepted by dental laboratories
unless they are disinfected. However, disinfection must be accomplished with-
out distorting the impression. Reversible and irreversible hydrocolloids, as well
as polyether impressions, should be avoided if they are to be disinfected, since
they lack the required stability. A guide for disinfecting impression materials may
be found in the ADA Council on Dental Materials, Equipment and Instruments
(COMEI, 1988 and 1992).
Impression Materials Merits. Elastomeric impression materials repro-
duce surface details very accurately, provided low viscosity formulations are used.
Since these materials are generally hydrophobic, they will not properly wet out
the surface of the tooth with saliva present. Contact angle studies of water on the
elastomeric impression surfaces for polyether, polysulfide, and addition silicones
show angles of 49.3◦ , 82.1◦ , and 98.2◦ , respectively, indicating that polyethers
work best where saliva cannot be excluded. The setting process for polysulfides
is highly susceptible to temperature and humidity, influencing working and set-
ting times. Condensation silicones may also show erratic setting, because of in-
adequate mixing and possibly some hydrolysis of TEOS. The setting behavior of
addition silicones and polyethers is the most consistent. Condensation silicones
are dimensionally less stable than polysulfides, addition silicones, or polyethers.
The contraction or shrinkage of condensation silicones, upon cooling from mouth
temperature (37◦ C) to room temperature, is ca 0.35%, compared to 0.20% for the
polysulfides. This shrinkage is essentially caused by release of alcohol generated
176 DENTAL APPLICATIONS Vol. 2
A variety of polymeric materials have been studied or used for preparing den-
tures, including epoxy resins, cellulose nitrate, rubber or vulcanite, phenol–
formaldehyde, vinyl acrylics, polystyrene, polycarbonates, and polysulfones, but
acrylics have become the materials of choice. It happens that compression-molded,
cross-linked acrylic dentures are as dimensionally stable and useful as the den-
tures made with special resins (4).
Denture wearers demand an accurate fit and natural appearance. The fit
is very important, since chewing efficiency of artificial dentures is substantially
lower than that of natural teeth. Besides being easy to fabricate, an ideal den-
ture material would have high strength, stiffness, hardness, and toughness, ie, be
fracture resistant, have low density, good dimensional stability, show resistance
to oral fluids, have an absence of odor or taste, be resistant to bacterial growth,
have good thermal conductivity, show good retention to other polymers, porcelain,
and metals, be radiopaque, be easy to repair, easy to clean, have good storage life,
and be inexpensive to make. Significant challenges remain to produce the ideal
denture material.
To achieve needed comfort, dentures must be custom-made. To form the cus-
tomized denture, in which the artificial teeth are embedded, a wax pattern is used.
The wax pattern is inserted in a plaster or dental stone in a split mold flask. After
removal of the wax, the surface of the resulting mold cavity is painted with a sep-
arating medium, usually an aqueous alginate solution, followed by the addition
of the acrylic resin. The separating medium aids in removal of the cured acrylic
from the mold.
Acrylic denture materials are made by free-radical (addition) polymerization,
using methyl methacrylate (MMA) monomer. In the process, the MMA becomes
poly(methyl methacrylate) (PMMA). The resins are available in either heat- or
cold-cured formulations. A cross-linking monomer, such as ethylene glycol (Fig. 5)
or diethylene glycol dimethacrylate (Fig. 5), is included with the MMA mixture
to improve the mechanical properties. The dimethacrylates are covalently bonded
at various points along the PMMA chains, forming a cross-linked matrix. Visible
light-cured versions have also become available, with the chemistry akin to that
of composite restoratives.
Heat-Cured Methacrylate Formulations. These resins consist of granu-
lar PMMA powder blended with liquid MMA, along with a cross-linking monomer,
as shown in Figure 5 (EGDMA or DEGDMA). After mixing and heating, the
monomer–polymer dough forms a rigid plastic. The powder component is mostly
granules of PMMA, along with benzoyl peroxide initiator (BPO, 0.5–1%), tita-
nium/zinc oxide pigments and opacifiers, dibutyl phthalate plasticizer, and acrylic-
or nylon-type reinforcing fibers. The liquid component contains the inhibited
MMA, along with a cross-linker (Fig. 5, DEGDMA). The blends, normally con-
sisting of about two to three parts of PMMA and one part of monomer by volume,
are packed with pressure into the mold, having the properly positioned teeth.
The MMA is normally inhibited with the methyl ether of hydroquinone (MEHQ)
or butylated hydroxytoluene (BHT). Small amounts of other acrylic monomers,
plasticizers, and 1–5% of a cross-linking agent may be employed. The polymeric
granules may also have methyl acrylate in the backbone or be plasticized by ethyl
or butyl methacrylate or ethyl acrylate to increase solubility in the monomer
syrup. Particle size and molecular weight distribution of the PMMA controls the
solubility of the polymer and the working consistency of the mixture. Traces of
poly(acrylic acid) or soluble starch suspension agents may remain in the polymer,
preventing wetting of the beads by the monomer. The residual initiator content
of the polymer beads may be at the level to obviate the need of further BPO to be
added to the mix.
Most dentures are fabricated from the heat-cured formulations with the poly-
merization rate increasing directly with temperature, proportional to the square
root of the initiator concentration. The half-life temperature (t1/2 , ◦ C) for BPO at
72◦ C is 10 h (5). The customary curing cycle of the fully mixed powder/liquid blend
is about 90 min at 65◦ C. Post-curing is usually done at 100◦ C for 60 min so as to
produce a more fully cured denture with low porosity. After cooling, the denture
is separated from the embedding material, trimmed, and polished. Red fibrous
materials and beads of varying translucency are added in small amounts prior to
curing so as to simulate the appearance fo natural oral-tissue.
Autopolymerizing Resins. Room temperature (RT) curing, initiated by a
suitable redox (oxidizer–reducer) combination, is a simple modification of the heat-
cured formulations. In such formulations tertiary aromatic amines, such as N,N-
dihydroxyethyl-p-toluidine or p-N,N-dimethylaminophenethanol (6), are added at
about the 0.3–0.8% level to the monomer, which is subsequently blended with a
polymer containing 2% BPO. The rate and degree of polymerization depends on
both the type and concentration of initiator (BPO) and activator (amine), as well as
the particle size of the PMMA powder. Techniques for preparing the molding are
very similar to the procedure described for heat-cured dentures. In this procedure,
the freshly mixed monomer–polymer blends are more limited in use because of
the handling characteristics of the formulations, ie, the polymerization is slightly
delayed upon mixing. The rise in temperature depends on the mass of material
and the powder/liquid (P/L) ratio used. Since polymerization occurs from inner to
178 DENTAL APPLICATIONS Vol. 2
outer portions of the mass, temperatures within the bulk portion of the casting
are higher than those at the surface. The cured dentures are usually not very
porous, since monomer evaporation is limited. The bulk of the polymerization
takes place within 30–45 min, but may continue for hours. The denture flask is
therefore held under pressure for several hours so as to ensure complete curing.
Room-temperature cured materials usually contains about 3–5% free monomer,
compared with only 0.2–0.5% found in heat-cured materials. Thus, this method of
curing is not as efficient as the heat-cured process, since the product produced has
less cross-linking density and a lower T g than the heat-cured materials. The latter
factors also make these RT-cured materials more susceptible to creep, eventually
creating distortion in the denture. The larger the amounts of free monomer present
in the final product, the greater the propensity for warpage to occur. Materials
generated by using amines in the curing have poorer color stability upon aging.
Blue dye, a ultraviolet absorber (7), may be added to the formulation to mask color
shift. Production of high dimensional accuracy is one of the main advantages of
RT-cured resins, resulting from lower curing temperature leading to reduction
of stresses in the matrix. Differences between thermal expansion of the denture
resin and the plaster mold may result in undesired dimensional changes when the
mold is subjected to a wide temperature range during processing. Dentures cured
at RT have better dimensional accuracy (8,9) than heat-cured dentures. However,
both are clinically acceptable.
Low Viscosity, Chemically Cured Resins. The pour and cure acrylic
resins are blends of high molecular weight polymer powder mixed with monomer
and other additives to achieve a pourable viscosity. The mixture is usually poured
through sprues into a hydrocolloid-based mold, with polymerization conducted
under pressure for about 30 min at RT (10). This procedure for preparing dentures
is inferior to heat- and cold-cured acrylics. However, it is an excellent technique for
denture duplication. Polymerization shrinkage is a problem for this type of system,
possibly causing posterior teeth to be displaced in the resilient mold and out of the
desired occlusal pattern (11). Methods have been developed to improve the latter,
by increasing the bond of acrylics to denture teeth (12). This technique requires
great attention to detail in order to produce clinically acceptable prostheses.
Visible Light-cured Resins. Employing high intensity visible (blue) light
to bring about free-radical polymerization (curing) of the denture resins holds
great promise (13). A photopolymerizable formulation in this case could consist of
a urethane dimethacrylate–acrylic polymer combination, reinforced with a micro-
fine silica filler. Thus, the materials produced have more in common with a com-
posite restorative material than with the commonly used denture-based resins.
The matrix produced is a highly cross-linked acrylic, having an interpenetrat-
ing polymer network (IPN)-type structure. MMA is not used in the urethane
dimethacrylate (Fig. 8) cross-linked IPN matrix, filled with colloidal silica and
acrylic polymer beads. Akin to composite restoratives, the formulation makes use
of the camphorquinone–tert-amine initiator system. With the exception of brittle-
ness, the cured materials have properties as good or better as the denture mate-
rials made by the methods described earlier. This technique shows good potential
for expanded use.
Mixing/Working Properties. For denture resins certain aspects are im-
portant to note. First, great care needs to be taken to use the correct P/L ratios,
Vol. 2 DENTAL APPLICATIONS 179
usually about 2.0/1.0 wt% or 1.6:1.0 vol%. Too much powder will result in under-
wetting of the beads, leading to production of a weak structure. Conversely, too
much monomer will produce excessive shrinkage. All ingredients must be thor-
oughly mixed to achieve the best results. A separating medium must be used to
prevent adhesion of the resin to the mold surface. Control of porosity and preven-
tion of processing stress are also two areas of concern. Polymerization shrinkage
and escape of volatiles can generate porosity.
Concerning shrinkage, volume reduction of about 20% for the monomer is
minimized by using polymer (PMMA) powder, cutting shrinkage to about 5–8%. It
is very important that this contraction is not translated into the high linear-type
contraction, which on the basis of volumetric shrinkage should be about 1.5–2.0%,
but is actually in the range of about 0.20–0.5%. The observed change is probably
due to thermal contraction, caused by temperature changes, and not to actual
polymerization shrinkage. The resin becomes very rigid once the temperature of
the reaction descends below the T g of the material, at which point the curing con-
traction will have essentially been completed. From this point onwards thermal
contraction contributes to dimensional changes of the denture material. Because
of the latter, cold-cured dentures should have a better fit, since the processing
temperature is considerably lower, ca 60◦ C, compared to heat-cured dentures at
ca 100◦ C. Thus, it is very important to pack the viscous mix in the mold in suffi-
cient quantity to create pressure, facilitating removal of voids and helping to cut
down on curing contraction. In all systems, polymerization generates an exotherm,
which might elevate to the point of causing monomer vaporization and creating
porosity. Thus, temperatures of cure should be controlled to avoid gaseous porosity
and pressure maintained to eliminate contraction porosity. Dimensional changes
also give rise to internal stress, which if allowed to relax may lead to warpage, craz-
ing, and distortion of the denture. The use of acrylic teeth, rather than porcelain
teeth, eliminates differential shrinkage, helping to reduce strain. Craze develop-
ment is another problem that may develop in dentures as a result of strain relief,
polishing, presence of alcohol, and differential contraction due to the type of teeth
used. Cross-linking helps reduce craze formation. A brief summary of the denture
materials’ properties is shown in Table 1.
Biocompatability. PMMA is highly biocompatible, with very few patients
showing any type of allergic reaction. Adverse reactions are usually caused by
leachable monomers. Cold-cured formulations may be a problem, since they tend
to have more residual, free monomer. Post-curing of the denture helps lower free
monomer content, but may also cause some denture distortion.
Dimensional and Mechanical Properties. Even though the denture is
placed on soft tissues, there is still great need for the denture to have dimensional
stability. The denture must fit as accurately as possible to promote retention of
the denture to the mucosa. As shown in Table 1, there is a considerable variation
in mechanical properties, depending on composition, processing technique, and
environment factors. Room-temperature cured resins have lower strength and
stiffness, with about the same elastic modulus as heat-cured materials. Polymer-
ization shrinkage of the monomer–polymer dough is about 6–7%. Linear shrink-
age is about 0.5% across the posterior aspect, under normal denture processing.
Water sorption, about 1–2 wt%, partially compensates for the shrinkage. Linear
shrinkage of 0.3–0.4% is clinically insignificant, since the tissue on which the
180 DENTAL APPLICATIONS Vol. 2
denture rests adjusts to such changes (14,15). Some cross-linked resins contain 2-
hydroxyethyl methacrylate (HEMA), which promotes higher water sorption, low-
ering dimensional stability. Fillers reduce the thermal expansion of the dentures,
providing higher impact strength. However, they are difficult to polish, tend to
stain, and may collect debris and imbibe bacteria at the surface.
It has been clearly shown that radiopaque materials are needed (16,17) for
visualization of aspirated or swallowed denture fragments. This is accomplished
with additives such as barium sulfate, barium fluoride, barium or bismuth glasses,
and halogenated organic compounds. The physical properties of the materials are
significantly affected by large quantities of these additives. ANSI/ADA specifica-
tions or requirements for radiopaque materials for denture-based polymers have
been described (18).
While commercial denture materials are reasonably strong and show good
flexibility, improved fracture resistance and fatigue strength are still sought. Seek-
ing to improve such things as fracture toughness, impact and transverse strength,
tensile strength, etc, various types of fiber (glass, carbon, Kevlar, and polyethy-
lene) reinforcement have been found to significantly improve many of the afore-
mentioned properties (19). Glass fiber reinforced composite resins have also been
introduced as a replacement for metal framework in crown and bridges or fixed
partial dentures as per recent clinical studies (20). Yet, research is still needed
to develop improved materials, pointed toward reducing the need for denture re-
pair (21). ANSI/ADA Specification No. 12 sets the requirements for denture-based
Resins.
Polymeric Teeth for Dentures. Acrylic resin denture teeth were intro-
duced in the late 1930s. About 60% of all preformed artificial teeth used in den-
tures, at least in the United States are produced from acrylics or vinyl acrylic
resins. The chemistry used is based on the well-known MMA polymerization
Vol. 2 DENTAL APPLICATIONS 181
technology. Poor wear, crazing, blanching, fracturing, etc, found in earlier acrylic
teeth, has been overcome by better methods of fabrication, improved formula-
tions, and use of higher cross-linking density. The molding technique for prepar-
ing the teeth must be highly controlled, with respect to particle size, molecu-
lar weight, and residual initiator. Further, the mix flow properties and curing
cycle must be highly controlled. Mechanical retention serves, to some degree,
to anchor the teeth in the chemically activated denture-based resins. However,
a combination of mechanical and chemical bonding is used to retain the teeth
(22).
Polycarbonates and polyslfones have also been explored for producing molded
teeth. Compositions containing very finely dispersed spheres of pyrogenic silica
as reinforcing fillers, urethane dimethacrylate (Fig. 8) resin, highly cross-linked
IPNs, and the fabrication of layered teeth with an exterior made up of a 2,2-
bis-p(2 -hydroxy-3 -methacryloxypropoxy)-phenylpropane (BisGMA)-based resin
have also been explored (23). All formulations employ pigments to provide a natu-
ral appearance. Other additives/modifiers are also used to achieve a more natural
appearance.
Acrylic teeth, with compressive strength of 76 MPa (11,000 psi), abrasion
resistance, elastic modulus of 2700 MPa (3.9×105 in. − 2 ), elastic limit of 55 MPa
(8000 psi), Knoop hardness (KHN) range of 18–20 kg/mm2 , and good abrasion
resistance, have physical properties which are lower than those of metal alloys
used for dentures and those of human enamel or dentin. For example, dentin and
enamel have an ultimate compressive strength of 297 and 384 MPa, respectively,
and ultimate tensile strength of 105.5 and 10.3 MPa, respectively. Furthermore,
the low modulus of elasticity in plastic teeth reduces the clicking sound often
exhibited by denture wearers. Compared to porcelain teeth, acrylic teeth have
less resistance to creep, higher water sorption, greater fracture toughness, better
resistance to thermal shock, and bond to the denture base. In contrast, porcelain
teeth display better dimensional stability and increased wear resistance. A study
of plastic teeth opposite plastic teeth or opposite smooth porcelain teeth has been
published (24). Plastic teeth are covered by ANSI/ADA Specification No. 15.
Denture Repair Resins. Fractured dentures are readily repaired with
materials similar to the RT- or cold-cured denture resins. Repairs are achieved
with little to no dimensional change. However, the strength of the repaired den-
ture may be substantially less than the original prosthesis (25). ANSI/ADA Spec-
ification No. 13 (1999) sets the requirements for cold-cured repair resins.
Denture Liner Materials. There are three groups of these materials: hard
and soft liners and tissue conditioners. It is often necessary to refit the denture
because of the changes in the denture-bearing tissue. To meet this need a hard
relining material can be employed, using an RT- or cold-cured acrylic resin at the
dentist’s office, or by sending the denture to a laboratory to be repaired with a
heat-cured acrylic resin. Soft liners weaken the strength of the heat-cured resins,
since they can reduce the thickness of the denture base and allow diffusion of
monomer or solvent into the base. The cold-cured formulations are basically of
two types: a two part PMMA powder blended with MMA monomer, containing
the plasticizer di-n-butyl phthalate or poly(ethyl methacrylate), PEMA powder,
blended with liquid butyl methacrylate (BMA) monomer. The BPO–amine redox
initiator system is used for curing. The use of PEMA and BMA works best where
182 DENTAL APPLICATIONS Vol. 2
the patients may be sensitive to PMMA or MMA. However, the use of PEMA and
BMA creates a liner with a lower T g , which may create dimensional problems. The
liners must show good adhesion to the denture, allow recovery from deformation,
provide a good cushioning effect, have good wetability, be relatively resistant to
oral fluids, not support bacterial growth, not impair denture function, and be
easily cleaned. At present, a material awaits discovery for fulfilling all of these
requirements. Polyphosphazine fluoroelastomers have been formulated and cured
with peroxides (26), showing that systems may be found to eliminate some of the
deficiencies found in currently available liners.
Soft liners were developed to eliminate the use of MMA directly against soft
tissue. Also, there are patients who are not able to tolerate a hard relining surface,
even though the denture fits well. The soft liner is more comfortable and provides
a means of absorbing masticatory forces via the highly resilient material placed
between the denture and the soft oral tissue. In addition, soft liners may be used
to reduce tissue inflammation caused by worn out or ill-fitting dentures. Polymers
with a T g slightly above the mouth temperature exhibit a rubbery behavior in the
oral cavity. A variety of materials have a T g low enough to be useful as soft liners,
including silicones and acrylics. PMMA is also useful when plasticized to obtain
the required T g . Fortunately, acrylic monomers are available which produce poly-
mers with a wide range of T g , starting with PMMA at 105◦ C, PEMA at 65◦ C, and
poly(n-butyl methacrylate) (PBMA) at 20◦ C. They are all useful for producing soft
liners. The soft liners are generally supplied as powder-liquid kits or ready-to-use
sheets. Materials currently available are usually plasticized acrylics. All formu-
lations contain fairly high molecular weight acrylate or methacrylate polymers or
copolymers, derived from ethyl, n-propyl, n-butyl, etc, monomers and a liquid or
solvent, such as ethyl alcohol or ethyl acetate, a plasticizer, such as dibutyl phtha-
late, and a polymerizable monomer. The T g of the material is set to ≤47◦ C. The
materials adhere well to denture-based resins. But, they have poor elasticity and
harden upon aging because of the loss of the plasticizer (27–30). More hydrophilic
liners have been formulated by using HEMA or other copolymers (28). However,
HEMA-based resins may soften and swell excessively due to water sorption, lead-
ing to undersirable functional changes.
Silicone liners are similar in composition to the previously described elas-
tomeric impression materials, which are produced by condensation polymeriza-
tion. Systems for the relining application may be either a one-component system,
which cures in the presence of moisture or heat, or a two-component system, con-
taining base and catalyst. Both types generally have poor adhesion to the denture
surface, and can readily support bacterial growth.
Tissue Conditioners. These products alleviate discomfort from soft-
tissue injury or inflammation. Tissue conditioners are soft materials applied tem-
porarily to the denture fitting surface, allowing better distribution of stress. They
exhibit viscous flow under pressure, forming a very soft cushion between the hard
denture and the soft tissue. In terms of softness, the material must not be too soft
or flow to the extent that it will be displaced from between the denture and the mu-
cosa. These materials may consist of PEMA powder mixed with a solvent (such as
ethyl alcohol) and a plazticizer (such as n-butyl phthalate and n-butyl glycolate)
(31,32). The alcohol swells the PEMA beads, rapidly promoting diffusion of the
plasticizer into the polymer, yielding a plasticized gel. Alcohol and plasticizer are
Vol. 2 DENTAL APPLICATIONS 183
slowly leached out from the applied gel, which may cause the material to become
too rigid. The liner must be replaced every few days to retain properties, until the
patients supporting tissues return to normal state.
Crown and Bridge Temporary Resins. Materials used in this area are
usually based on methyl or ethyl methacrylates and BisGMA-acrylics mixtures
(20), or even an ethyleneimine-terminated monomer (33). The formulations are
supplied as a two-component paste, composed of monomers and polymerization
initiator. Used for interim tooth coverage, these materials are not as strong as
other acrylics. However, they exhibit good flow, low exotherm, and low curing
shrinkage. They maintain the correct biting relationship, stop teeth drifting, and
protect the prepared tooth against fracture, while waiting for the permanent pros-
thesis to be delivered.
Polymeric materials are also used for fixing veneers on crown and bridges.
Polymers used for this application include acrylics, vinyl acrylics, and dimethacry-
lates, as well as silica- or quartz-microfilled composites. After placing on the metal-
lic substrates of the prostheses, the materials are heat or light cured. These ma-
terials are easy to fabricate, and can be readily matched to the color of the tooth
structure. The acrylic facings have poor adhesion to the metals, being retained only
by curing the monomers into mechanical undercuts designed into the metal sub-
strate. They have less mechanical strength, less color stability, poorer abrasion,
etc, than normal dental composites, along with deforming more under bruxism.
With the advent of porcelain fused to metal crowns and bridges, restoratives with
polymeric veneers are less frequently used.
Mouth Protectors. The widespread growth of contact sports has acceler-
ated the use of mouth guards (34,35). Guards may be produced from natural rub-
ber, poly(vinyl chloride), poly(vinyl acetate-co-ethylene), or polyurethane materi-
als. Customized guards are often fabricated from poly(vinyl acetate-co-ethylene)
blanks, soft acrylic dough, liquid rubber latex, polyurethane, and laminated ther-
moplastic (36,37). Over the counter protectors usually fit poorly, in contrast to
dimensionally stable and comfortable, customized mouth protectors.
desired materials. The loss of plasticizer and lack of stability decreases the use of
these materials.
Silicones. These materials have some only recently been used to produce
maxillofacial prostheses. Both the RT- and heat-vulcanized materials may be used.
Heat-vulcanized formulations are supplied as a semisolid or putty-like material,
which requires the addition of colorants. The molded material is cured under
pressure at 180◦ C/30 min. The heat-cured materials exhibit better strength and
color stability than the RT-cured materials.
Polyurethanes. This is the most recent material used in maxillofacial ap-
plications. Fabrication requires accurate proportioning of the components. The
isocyanate and polyol are blended, placed in a suitable mold, and allowed to cure
at room temperature. Colorants and other additives are also used in the formula-
tions. Even though the fabricated prosthesis has a natural feel and appearance,
the final product is still relatively unstable.
Root-Canal Sealants
A variety of materials have been used to hermetically seal the root canal, prevent-
ing ingression of oral fluids into the canal. One natural material used is gutta-
percha (Fig. 6), a rubber obtained from the Taban tree. This material has been
used in endodontics for over a hundred years. Rubbers are polymers of 2-methyl-
1,3-butadiene (isoprene), having two possible conformations, ie, a cis and trans
form, with the trans form being gutta-percha. These rubbers are hardened by vul-
canization, achieved by blending and heating with a few percent of sulfur, which
causes cross-linking. A typical formulation used in a root canal has about 19–22%
gutta-percha, 59–75% zinc oxide filler, 1–17% heavy metal salts, and 14% wax
plasticizer. The material softens at about 60–65◦ C and melts in the vicinity of
100◦ C, providing a temperature range to soften, deform, and condense the mate-
rial into the prepared root-canal space. Other materials used for endodontically
treated, fractured teeth are based on zinc oxide-eugenol, epoxy resin, polyvinyl
resin, calcium hydroxide resin based formulations, and glass-ionomers formula-
tions.
Other Uses
Patterns for gold-inlay castings can be prepared from acrylics. Castings made
this way are not superior to castings produced from a wax pattern, accounting
for the lack of interest in this technique. Some dental laboratories use epoxy die
Vol. 2 DENTAL APPLICATIONS 185
Restorative Materials
composite restoratives have recently been compared (167), with this and other
efforts showing that the mechanical properties of compomers, as well as their re-
sistance to wear, are significantly better than both conventional- and VLC-type
GIs. The compressive strength and diametral tensile strength for compomers is in
the range 280–460 MPa and 52–62 MPa, respectively, with polymerization shrink-
age in the range of 2.0–3.0%, and the coefficient of thermal expansion (ppm/◦ C)
being in the range 12–41. The reported coefficient of thermal expansion for coro-
nal tooth structure is about 11 ppm/◦ C. Clearly, research on compomers suggests
that there are still others ways to be discovered for improving the handling char-
acteristics and compensating for polymerization shrinkage in the design of dental
restoratives.
Sealants
A variety of sealants have been explored or developed (168), with many people
having one or more applications of a sealant. Sealants are vital for promotion of
adhesion, which significantly reduces caries formation (169–177). Pit and fissure
sealants are covered under the American Dental Association (ADA) Acceptance
Program. These materials are used to seal high caries-susceptible pits and fissures
of the deciduous and permanent molars, and also to seal microspaces between
the tooth and restorative materials, enabling these materials to adhere firmly
both to prepared cavity walls and to other restoratives. They provide dental pulp
protection and protection from secondary caries formation.
Most dental sealants are resinous materials derived from free-radical poly-
merizable monomers, but GI dental cements (discussed earlier) also have some use
as sealants. Sealing with resinous materials or GIs is part of modern preventive
technology, where the sealants used for this purpose are called preventive dental
sealants (PDS). Dental caries that occur around restorations are called secondary
caries. Sealing the microspaces with adhesive resinous materials is effective in
controlling secondary caries; here we call these adhesive materials the restorative
dental sealants.
A brief history and state-of-the-art ion enamel and dentin bonding was pub-
lished in 1995 (178). Recent advancements in synthetic chemistry and polymer
science of dental sealants are now briefly reviewed or discussed, including those
designed for various clinical uses, directed toward prolonging the lifetime service
of natural teeth.
Preventive dental sealants, used to seal the susceptible areas of teeth, are
classified into pit and fissure sealants and smooth surface sealants. From a ma-
terial science perspective, pit and fissure sealants can be further classified into
resin sealants and GI cements. Preventive dental sealants are usually placed
onto molar teeth of young children who are at high risk for caries develop-
ment.
Pit and Fissure Sealants. Resin sealants consist of a free-radical poly-
merizable monomer mixture, having a viscosity low enough to penetrate easily
into narrow pits and fissures, capable of being cured to a hard and durable sealing
material. BisGMA, urethane dimethacrylate, and other methacrylates are very
popular as monomers for resin sealants, along with other monomers, to lower
Vol. 2 DENTAL APPLICATIONS 193
method for a dentin bonding system which will produce a very durable bond with
total elimination of future microleakage (192–194). Composite resin polymeriza-
tion shrinkage is the main reason for marginal gaps and stress at interfaces,
leading to microleakage (192,195). Thermo- and load-cycling studies are essen-
tial for determining or predicting the dentin-restoration bond longevity (196,197).
Apart from using simple acid etching, the evolutionary development of surface-
active comonomers with both hydrophilic and hydrophobic moieties, as part of
the primer system, has made a very significant impact on improving bonding to
dentin (198–201). The work on self-etching primers, to improve the understand-
ing of what it takes to bond well to dentin, also played a very important role
in the design of improved dentin bonding systems (202–206). For specific infor-
mation on some of the most recent, commercial enamel and dentin bonding sys-
tems, see literature on Excite (Ivoclar AG or Vivident), Single Bond (3M Dental
Products), One Step (BISCO), Prime Bond (Dentsply/DeTrey), and Optibond Solo
(Kerr Sybron).
Dental Restorative Sealants. Dental amalgams are mixed and con-
densed into molar teeth cavities, hardened by the amalgamation process. The
amalgam has no chemical interaction with the cavity wall, and irregular mi-
crospaces are produced along the interface between them. Amalgam sealant and
amalgam bonding agents are used to seal the microspace and control the inci-
dence of secondary caries around the amalgam restoration. Chemical composition
of this sealant or bonding agent may be as follows: a monomer such as diethylene
glycol dimethacrylate (Fig. 5) or a comonomer such as methacryloxyethyl phtha-
late (MEP). Other formulation additives may be tert-butyl hydroperoxide initiator,
o-sulfobenzimide accelerator, and hydroquinone inhibitor.
This sealant is composed of only one liquid, which remains uncured before
application, but cures quickly once applied to amalgam. Because of tert-butyl hy-
droperoxide and o-sulfobenzimide, polymerization occurs anaerobically when it is
cut off from air and it contacts the copper in the amalgam. When placed between
two glass plates at 25◦ C, it takes more than 10 min to cure. However curing occurs
within 2 min between a glass plate and the amalgam. The MEP (207) monomer
is used to enhance penetration of the sealant into micro spaces and achieve adhe-
sion to both arnalgam and tooth surface. This sealant achieves amalgam–enamel
bonding by about 1.0 MPa and bonds amalgam–dentin by about 2.6 MPa without
acid etching. Examples of two amalgam bonding agents illustrate the latter, brief
discussion.
Amalgam Restorative Sealants. These adhesives are of two types: adhe-
sive resin cements and bonding agents originally developed for composite restora-
tions. One commonly used adhesive resin cement is Amalgambond (Sun Medical
Co., Japan), which consists of PMMA powder and MMA monomer, containing
4-methacryloxyethyl trimellitate anhydride (4-META) and tributylborane oxide
(TBB-O) as a catalyst. TBB-O is activated by the water on the surface of adher-
ents and promotes graft polymerization of MMA onto collagen in dentin, promoting
strong adhesion (201,207,208).
Panavia 21 (Kuraray Co., Japan) is an adhesive cement, characterized by
the use of 10-methacryloyloxydecyl dihydrogen phosphate (MDP). This cement
consists of a primer and a composite paste. The primer is a monomer solution
containing MDP, which develops strong adhesion to enamel and dentin. The
Vol. 2 DENTAL APPLICATIONS 195
Various materials such as polymers, alloys, ceramics, and composites are used to
restore or replace tooth structure. It is vitally important for these materials to
be bonded securely to the tooth surface. Lack of bonding between the materials
and tooth will induce secondary dental caries or restoration detachments. Recent
dental adhesive techniques are based on chemo-mechanical bonding between the
adhesive and adherend.
Surface conditioning before applying adhesives effectively increases the sur-
face bonding area and enhances the strength of the bonding agent. The enamel is
commonly etched with an aqueous solution of phosphoric acid or other acids. Most
current enamel bonding systems employ phosphoric acid in various concentrations
and viscosities as an etchant (169,170).
196 DENTAL APPLICATIONS Vol. 2
Casting alloys in dentistry are categorized into base metals and noble metals.
Base metals include cobalt–chromium (Co–Cr), nickel–chromium (Ni–Cr), and ti-
tanium (Ti) alloys, while noble metals include gold (Au), silver (Ag), and palladium
(Pd) alloys. Mechanical methods, such as air-abrading with 50–200 µm alumina,
are the most common way to prepare the alloy surface. Electrolytic etching creates
micro-mechanical retention on the alloy surface. Other types of surface modifica-
tion include electroplating, silica coating, and ion-coating.
Dental ceramics consist mainly of metal oxides of silicon, aluminum, potas-
sium, and sodium. Etching with an aqueous solution of hydrofluoric acid roughens
the ceramic surface.
The roughened, adherend surface is treated with a primer for chemical
bonding. Because the composition of dental adhesives is based on methacrylate
monomers, the primers for chemical bonding also contain functional monomers.
The functional monomer usually consists of a polymerizable methacrylate or vinyl
group, a hydrophobic intermediate spacer, and a functional group capable of bond-
ing to the adherend surface. Functional groups effective for bonding base metal
alloys are the acid anhydride, carboxylic acid, and phosphoric acid groups. Thiol
derivatives are used to prime noble metal alloys. The dental ceramic surface is
primed with silane couplers activated in acids, such as carboxylic acid monomers,
ferric chloride, and/or a tri-n-butylborane derivative (TBB) (212,213). Silane cou-
plers are also used for surface modification of filler particles included in dental
composites (214).
After surface preparation, the restorative material is bonded to the tooth
structure with auto-polymerizing adhesive resin. One prerequisite for dental ad-
hesives is an ability to cure in the mouth; that is why methacrylate-based polymer
materials are used in dentistry. Initiation systems are BPO–t amine or TBB (201).
Monomers used are MMA or bifunctional methacrylate monomers. The needed
optical opacity (215,216) is achieved by various inorganic and metal compounds
incorporated into the formulations.
Acid anhydride or acidic monomers, such as 4-methacryloxyethyl trimel-
litate anhydride (4-META), 4-methacryloxyethyl trimellate (4-MET), 4-(3-
methacryloyloxypropoxy carbonyl) phthalic anhydride (MPRPA), and 4-(4-
methacryloyloxybutoxycarbonyl) phthalic anhydride (MBPA), prepared by
condensing hydroxyalkyl methacrylates and trimellitic anhydride acid chloride,
are very important coupling agents. The phosphoric acid derivative, MDP is
synthesized from methacrylic acid, 1,10-decanediol, and phosphorus oxychloride.
These very useful, functional (polymerizable) monomers are added to the primer
or liquid part of the adhesive.
The MMA-based adhesive system, 4-META/MMA–TBB resin formulation,
has three components: initiator, monomer liquid, and powder. The initiator is par-
tially oxidized TBB (TBB-O). The monomer liquid contains 5% 4-META in MMA.
The powder is finely pulverized PMMA, with a number-average molecular weight
of about 100,000. The original MMA–TBB resin without 4-META is a transparent,
unfilled resin. Bonding to enamel and base metal alloys is improved by addition of
4-META monomers to the liquid part. A primer containing 0.5% 6-(4-vinylbenzyl-
n-propyl)amino-1,3,5-triazine-2,4-dithol (VBATDT) in acetone is used to bond no-
ble metal alloys. Mercaptan (SH) groups on the VBATDT monomer bond to noble
metals and copper on the alloy surface. The ceramic surface is treated with a
Vol. 2 DENTAL APPLICATIONS 197
two-part liquid primer before applying 4-META resin. One liquid contains 4% γ -
methacryloxypropyl trimethoxysilane (γ -MPTS), while the other liquid contains
5% 4-META (or 4-MET) in MMA or 0.5% ferric chloride in ethanol. The γ -MPTS
is activated by mixing with 4-META (or 4-MET) or ferric chloride to silanate the
dental ceramic surface. The use of MMA polymer (PMMA)-coated titanium oxide
(217) makes 4-META/MMA–TBB-O resin optically opaque.
Shear bond or tensile tests determine the dental adhesive bond strength,
with thermocycling in water effectively evaluating the bond durability. The
monomer VBATDT is effective for bonding Ag–Pd alloy, while 4-META is suit-
able for Ni–Cr alloy and titanium. For Ni–Cr alloys, the chromium content influ-
ences bond durability. Ferric chloride combined with a silane coupler significantly
improves the bond strength of 4-META/MMA–TBB-O resin joined to dental porce-
lain.
Ceramic restoratives are often bonded directly to the tooth surface with ad-
hesive resins, reducing the amount of healthy tooth reduction needed in clinical
treatment. Resin-bonded fixed partial denture or resin-bonded ceramic restoration
methods are often employed. Adhesive resins are also used for bonding orthodontic
brackets, amalgam restoratives, and many other metal and ceramic materials.
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GENERAL REFERENCES
K. J. Anusavice, Phillips Science of Dental Materials, 10th ed., The Saunders Press,
Philadelphia, Pa., 1996.
R. van Noort, Dental Materials, 1st ed., C. V. Mosby Co., St. Louis, Mo., 1989.
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Vol. 2 DIACETYLENE AND TRIACETYLENE POLYMERS 203
C. M. Sturdevant, The Art and Science of Operative Dentistry, C. V. Mosby Co., St. Louis,
Mo, 1997.
A. D. Wilson and J. W. McLean, Glass-Ionomer Cement, Quint essence Publishing Co.,
Chicago, 1988.
A. D. Wilson and J. W. Nicholson, Acid–Base Cements: Their Biomedical and Industrial
Applications, Cambridge University, Cambridge, 1993.
BILL M. CULBERTSON
RONALD E. KERBY
The Ohio State University