BIOCOMPATIBILITY OF DENTAL

MATERIALS

DR JEEVAN
 CONTENTS
 Introduction

 Definition

 History

 Measuring biocompatibility

 Biocompatibility tests

 Invitro test

 Cytotoxicity test

 Test for cell metabolism / cell function

 Test that uses barriers / indirect test

 Other assay for cell function

 Mutagenesis assays
 Animal test
• Mucous membrane irritation test
• Skin sensitization test
• Implantation test

 Usage test
 Dental pulp irritation test
 Dental implants into bone
 Mucosa and gingival usage tests

 Correlation among invitro animal and usage test

 Standards that regulate the measurement of biocompatibility

 Ansi/ada document
BIOCOMPATIBILITY OF DENTAL MATERIALS
 Reactions of pulp
• Microleakage
• Dentin bonding
• Bonding agents
• Resin based materials
• Amalgam and casting alloys
• GIC
• Liners , varnishes and non-resin cements
• Bleaching agents
 Reaction of other oral soft tissues to restorative materials

 Reaction of bone and soft tissues to implants materials

• Reaction to ceramic implant materials

• Reactions to implant metals and alloys

• Reactions to resorbable materials

 Clinical guidelines for selecting biocompatible materials

 Summary

 Conclusion

 References
What is BIOCOMPATIBILITY?

 Ability Of a Material To Perform With Appropriate Host Response In a

Specific Application .

 Capacity of the material implanted in the body to exist in harmony

with tissue without causing damage.
HISTORICAL BACKGROUND
 Although the concept of the ethical treatment of patients extends back to the time of

Hippocrates (460-377 BC) the idea that new dental materials must be tested for safety and

efficacy before clinical use is much more recent.

 As late as the mid 1800s,dentists tried new materials for the first time by putting them into

patients' mouths.
 Many exotic formulations were used. For example, Fox developed a "fusible

metal“ that consisted of bismuth, lead and tin which he melted and poured into

the cavity preparation at a temperature of approximately 100 ºC.

 Even G.V. Black used patients to test many of his new ideas for restorative

materials such as early amalgams.

 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 increase.

 The concept of protecting the patient as a research subject is only 30 to 40 years old.

 Also, many of the regulations and ethics in this area are still being challenged and defined

today.
 MEASURING THE BIOCOMPATIBILITY:

 Biocompatibility of a material cannot be evaluated by using a single test

rather than a group of various techniques.

 The initial tests (phases i and ii) are of a short duration, simple and cost
effective.

 Only after completing initial test, the material progresses from simpler in
vitro tests to the more complicated in vivo tests.

 Usage test can be performed in animals or humans (clinical trial).

BIOCOMPATIBILITY TESTS
1. IN VITRO TESTS
2. ANIMAL TESTS
3. USAGE TESTS
IN VITRO TESTS

 Outside body

 In vitro – Interaction of any

material on cell, enzyme or
any biological substance
isolated from organism.
IN-VITRO TESTS
 Direct – material physically in contact with cell

 Indirect –barrier present between cell and material

 Subdivided into measuring

Cell growth / cytotoxicity

Effect on genetic material in cell

Metabolic / other cell function

IN-VITRO TESTS
• Advantages

Quick, inexpensive, easy, standardized & well suited for large scale screening

• Disadvantage

Questionable relevance to final in-vivo study on same material & lack of inflammatory and

other tissue protective measures

 TYPES OF CELL USED:
a) PRIMARY CELL
 directly from animal into culture
 grow only for limited time in culture
 they retain many characteristics of cell in vivo
 more relevant
 Viral/bacterial agents may alter its behavior
b) CONTINOUS CELL
 Primary cells allowed to grow indefinitely
 Do not retain many characteristics of cell in vivo
 Consistently exhibit any feature that the pertain
 Genetic & metabolic stability
1. CYTOTOXICITY TESTS
 Assess by measuring the cell number/ growth after exposing to
material
 If cells remain attached to the well & proliferate with time – material is
not cytotoxic
 If cells stop growth, exhibit cytopathic features, & get detached from
well – material is cytotoxic
Cytotoxicity test
 Assess the Membrane Permeability : loss of membrane permeability
is equivalent to death!
 Identifies the cells that are dead or alive
 Two types of dye used:
a) Vital dyes
Actively transported to viable cells (neutral red, Na51CrO4)
Taken by vital cells & drained if cells injured
b) Non vital dyes
Transported if membrane permeability is compromised(trypan blue,
propidium iodine)
Taken by injured cells
 51Cr

51Cr

NR

NR
TB
HEALTHY CELL TB INJURED CELL
2.CELL METABOLISM / CELL FUNCTION TESTS

 Measurement of enzymatic activity of the cell

 Assess DNA & protein synthesis

 It is a colorimetric assays

 This measures the activity of cellular dehydrogenases

 Cellular dehydrogenase converts the MTT chemical to a
purple, insoluble formazan dyes

 If dehydrogenases are not active because of cytoxic effect

the formazan will not form

 Helps to asses the viability & proliferation of cell

 Quantified using spectrophotometer(500- 600nm wavelength)

 3.INDIRECT TEST

 Test that use barriers between cell & material

 No direct contact

 Agar overlay method : agar act as a barrier which is jammed between NR

stained cell layer & material.

 INFERENCE: If cells are injured, NR released leaving a zone of inhibition .

 MILLIPORE FILTER ASSAY:

a. Monolayer of cells on filters made of cellulose ester

b. Medium containing 1% agar allowed to gel over the cells

c. Sample material

Monolayer – gel is detached & turned upside down so that filter is on top for
placement of sample material
INFERENCE: if sample is cytotoxic, width of cytotoxic zone is assessed.

May be influenced by leaching of toxic products from test material

A : Test material placed
B : Device to hold dentin disk
C : Cell culture medium , Renewed via inlet & outlet.
4)OTHER ASSAYS FOR CELL FUNCTION

a) Immune function

b) CK production by lymphocyte & macrophages

c) Chemotaxis

d) Complement activation

e) T-cell rosetting to sheep RBC

Their significance is to reduce animal tests

5)MUTAGENESIS ASSAY

Assess the effect of material on cell`s genetic material

a) Genotoxic mutagens : directly alter DNA of cell. Each chemical has specific DNA

mutation. They mostly require activation or biotransformation (pro mutagens)

b) Epigenetic mutagens : support tumor growth by altering the cell`s biochemistry. Do not

directly alter DNA.

Mutagens may or may not be carcinogens & vice versa.

INFERENCE: chemicals that significantly increase the frequency of reversion back to native
state have high probability of being carcinogenic.
 STYLES` CELL TRANSFORMATION TEST:

 alternative to bacterial test

 Quantifies ability of potential carcinogens to transform a

standardized cell

 Transformed cells only grow within an agar gel.

 However, the Ames test is widely used, and technically

easier to conduct in a testing laboratory than the other

test, it is most often conducted in a screening program.

 ANIMAL TEST

Usually involving mammals such as mice, rats, hamsters, or guinea pigs, and are
distinct from usage tests in that the material is not placed in the animal with
regard to its final use.
Advantage :
• The biological responses in animal tests are more comprehensive and may be more
relevant than in vitro tests

Disadvantages :
• there can be difficulties to interpret and control, are expensive, may be time consuming,
and often involve significant ethical concerns and paperwork.
1)MUCOUS MEMBRANE IRRITATION TEST

to asses the inflammatory reaction

Place the test material , positive & negative control in contact with hamster cheek

pouch tissue or rabbit oral tissue.

After several weeks, tissue examined & photographed.

Animals are then sacrificed & biopsy specimen are prepared for histological examination.

INFERENCE : inflammation to mucous membrane

2)SKIN SENSITIZATION TEST (guinea pig maximization test)

 Assess skin hypersensitivity reactions

 Material injected intradermally into guinea pigs

 Followed by secondary treatment with adhesive patches

containing test material

INFERENCE : if hypersensitivity develop from initial treatment, patch

test will elicit an inflammatory response (no reaction to intense

redness).
3)IMPLANTATION TESTS :

 for materials in contact with subcutaneous tissue or bone.

 Amalgams & alloys (contact with gingiva)

 Aseptically place the compound in small, open ended

polyethylene tubes & then placed into the tissue.

 Allowed to remain for 1-11 weeks(short term) or for 1-2

years(long term test for identification of chronic

inflammation or tumor formation)

 INFERENCE : tissue response is evaluated by histological,

or histochemical methods
 USAGE TESTS
 GOLD STANDARD OF TESTS.

 Done in animals or human volunteers

 Situation identical to its clinical use (distinct from animal tests)

 Dogs or monkeys are used (similar oral environment to humans)

 If humans are used, its CLINICAL TRIAL.

Advantages
Relevance to use of material is assured

Disadvantages
These tests are extremely expensive, last for long periods, involve many ethical and
often legal concerns, and are exceptionally difficult to control and interpret
accurately.
1)DENTAL PULP IRRITATION TESTS :

Sample placed in class5 cavity preparation in intact non carious tooth

Allowed to remain for 1-8 weeks

INFERENCE: teeth removed & sectioned for microscopic examination shows necrotic &
inflammatory reactions of pulp.
Types of pulpal response:

a) Slight : Mild hyperemia, few inflammatory cells, slight hemorrhage in

odontoblastic zone

b) Moderate: Increase in number of inflammatory cell, hyperemia, slight disruption

of odontoblastic zone.

c) Severe: Increased inflammatory infiltrate, hyperemia, total disruption of

odontoblastic layer in the zone of cavity preparation, reduction or absence of

predentin , localized abscesses

2)DENTAL IMPLANTS INTO BONE :

Success of implants assessed by:

a. Penetration of periodontal probe along side of implant

b. Mobility of implant absent

c. Radiograph indicating either osseous integration or absence of radiolucency around

implant

d. Minimal vertical bone loss

Failure of implant was denoted by formation of wall of a cyst around the implant caused

by slow degradation of implant material into tissue

Fibrous capsule formation was a sign of irritation & chronic inflammation.

3)MUCOSA & GINGIVAL USAGE TESTS :
Materials place in cavity with subgingival extensions
Observed at 7th day & 30th day.
Response graded as:
a. Slight

Few lymphocytes in epith. & adjacent CT

b. Moderate

Numerous lymphocytes in CT & few neutrophils in epith.

c. Severe

Significant mononuclear & neutrophil infiltration & thinned or absent epith.

Perform oral prophylaxis before the test as bacterial plaque initiate inflammation in gingiva
that may hinder the response.
 CORRELATION OF TESTS
 Each type of test are designed to measure different aspects of biological response to

materials

 No single test would be adequate to completely characterize the biocompatibility of

a material.

 Method of diagnosis : PYRAMID TESTING PROTOCOL.

 All materials were tested at the bottom of the pyramid & materials were webbed out

as the testing continued to the top of the pyramid.

 EARLY STRATEGY

Progress of
testing
•Number of materials tested is represented by width of the triangle.

CLINICAL TRIALS •Unspecific toxicity :condition that did not necessarily reflect those of

materials use (in vitro or animal tests)

SPECIFIC •Specific toxicity : condition more relevant to materials clinical use.

TOXICITY

•Clinical trial : usage tests

UNSPECIFIC TOXICITY

No. of tests
CONTEMPORARY STRATEGY

Progress of
testing

•Primary tests : in vitro & in vivo tests

•Secondary tests: advanced biological tests

USAGE
•Usage tests :clinical trials

•The concept was similar to early scheme except types of tests were

SECONDARY extended to include other than toxicity, such as immunogenicity &

mutagenicity.

•Only material that passed the first tier of tests were graduated to
PRIMARY
second tier , & only those that passed second tier were graduated to

clinical trial.

No.of tests
FUTURE SRTATEGIES

 All three test done initially, but as testing progresses, usage test predominates. Primary &
secondary tests play a continuing but a decreased role as test continues
 The most common progression is from primary to secondary to usage test.

 Tests may be performed at any time depending upon the problems

encountered.

 Tests accurately screen in or out a material

 Assessing biocompatibility is an ongoing process.

 Who regulate the measurement of biocompatibility

ANSI/ADA specification 41
 This was approved by the council on scientific affairs in 1972 and was 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 10993

 ISO 10993- It is the international standards for testing the biocompatibility of dental
materials.
 Unlike ANSI/ADA document no. 41, the IS0 10993 standard is not restricted to dental
materials.
 The standard divides tests into initial and supplementary tests to assess the biological
reaction to materials.
 Reactions of pulp
MICROLEAKAGE
 There is evidence that restorative materials may not bond to enamel or dentin

with sufficient strength to resist the forces of contraction during polymerization,

wear, or thermal cycling

 If a bond does not form, or debonding occurs, bacteria, food debris, or saliva

may be drawn into the gap between the restoration and the tooth by capillary

action. This effect has been termed microleakage.

 concept of nanoleakage has been put forward. Like microleakage,

nanoleakage refers to the leakage of saliva, bacteria, or material components

through the interface between a material and tooth structure

 Dentin bonding
 Bonding to dentin has proven more difficult because of its
composition (being both organic and inorganic), wetness, and
lower mineral content.

 Smear layer S

 1- to 2-μm layer of organic and inorganic

debris.
 It was said to be impermeable but diffusion of
molecules as large as albumin (66 kDa) has
occurred through a smear layer.
P T
 Ethylenediaminetetraacetic acid (EDTA),
sodium hypochlorite, and proteolytic
enzymes.
 The acids used to remove the smear layer are a
potential source of irritation themselves (phosphoric,
hydrochloric, citric, and lactic acids).

 Dentin is a very efficient buffer of protons, and most of

the acid may never reach the pulp if sufficient dentin
remains.

 A dentin thickness of 0.5 mm has proven adequate.

 Many of dentin bonding agents are cytotoxic to cells

in vitro tested alone.
Bonding agents
 Bonding agents permeate up to 0.5 mm of dentin to cause
significant suppression of cellular metabolism
 Hydroxyethyl methacrylate (HEMA), a hydrophilic resin contained in
several bonding systems, is at least 100 times less cytotoxic in tissue
culture than Bis-GMA
 .However, if the dentin in the floor of the

cavity preparation is thin (< 0.1 mm), there is

some evidence that HEMA may be cytotoxic in
vivo.

E.g. : 1st generation, 2nd generation, 3rd

generation, 4th generation.
Resin based composites
 Freshly set , chemically cured and light-cured resins often cause moderate
cytotoxic reactions in cultured cells

 The cytotoxicity is significantly reduced 24 to 48 hours after setting and by

the presence of a dentin barrier

 The light-cured resins are less cytotoxic than chemically cured systems
 The pulpal inflammatory response to chemically cured and light-cured resin
composites is low to moderate after 3 days when they were placed in cavities with
approximately 0.5 mm of remaining dentin.
 Composite resins are cytotoxic in in-vitro tests of direct contact with
fibroblasts
 Probably because of unpolymerized components in the air-inhibited
layer that leach out from the materials.
 Some of the newer composites with non- BisGMA non-UDMA matrices
have significantly lower cytotoxicity
 Polished composites show markedly less cytotoxicity in vitro.
bis-phenol-A and bis-phenol-A dimethacrylate to cause estrogen-like responses in vitro.

 The effect on other oral tissues is not significant

PRECAUTIONS
 Beneath a composite resin restoration, a suitable base should be
placed to protect the pulp from material components and bacterial
toxins

 Inhalation of composite resin particles during grinding and shaping of

a newly placed restoration should be prevented by suitable
measures such as a rubber dam or the use of suction/water coolant.
 Protective shields should be attached to the end of the light guide of
polymerization lamps to protect the eyes of dental personnel
 Dental personnel should always avoid any contact of skin or even gloves with
resin-based composites or dentin
 Dental amalgam
 Biocompatibility of amalgam is determined largely by corrosion
products released while in service.

 Unreacted mercury from amalgam is toxic, but low-copper

amalgam that has set for 24 hours does not inhibit cell growth.

 Implantation tests show that low-copper amalgams are well

tolerated than high copper.
 Amalgam restorations carried into the gingival crevice causes inflammation of
the gingiva because of products of corrosion or bacterial plaque

 Even after 7 days after placing an amalgam, a few inflammatory cells appear
in the gingival connective tissue, and hydropic degeneration of some epithelial
cells may be seen
Amalgam

 Although copper enhances the physical properties of amalgam and is

bactericidal, it is also toxic to host cells and causes severe tissue reactions
in implantation tests.

 gallium-based alloys that have been used as amalgam replacements also

shows severe reactions.

 The cavity preparation should be lined for two other reasons

1. Thermal conductivity with amalgam

2. Margins of newly placed amalgam restorations show significant microleakage

DENTAL CASTING ALLOYS

 The biological response to an alloy depends on the biological

effects of released elements, the quantities released, the duration
of tissue exposure to these elements, and other factors

 A number of factors influence the corrosion of dental alloys

 Composition of the alloy (particularly at the surface)

 Surface structure (roughness, presence of oxides)
 Crevices, pits
 Thermal treatment/history
 Combinations of alloys (gold coating, soldering)
 gingivitis due to the PFM
crowns;

 after removal of the crowns

and seating of temporary resin
crowns
 Gold coating of nickel-based
and cobalt-based alloys.

 Pronounced redness of the

palate beneath the denture
base
 Perioral allergic reaction after insertion
of nickel-containing orthodontic wires
(Cu Ni Ti )

 Lichenoid reaction of the mucosa

contacting an alloy
 Pronounced gingivitis after seating of
ceramic crowns, despite good oral
hygiene

 Dental lab –Inhaled beryllium – berylliosis.

 GLASS IONOMER CEMENTS
 Glass ionomers are another type of material that have been used both as a
cement (luting agent)and as a restorative material.
 Freshly prepared ionomer is mildly cytotoxic

 Histological studies in usage test shows that any inflammatory infiltrate to GIC is
minimal or absent after 1 month

 There have been several reports of pulpal hyperalgesia for short periods (days) after
placing glass ionomers in cervical cavities.

 This effect is probably the result of increased dentin permeability after acid etching
or the high pH of the restoration.
LINERS, VARNISHES, AND NONRESIN
CEMENTS
 CALCIUM HYDROXIDE

 ZINC PHOSPHATE

 ZINC POLYCARBOXYLATE CEMENT

 ZOE CEMENT
CALCIUM HYDROXIDE CEMENT
ZINC PHOSPHATE CEMENT
 Zinc phosphate cement that was left in
the sulcus after cementation results in
periodontal destruction and bone loss
ZINC POLYCARBOXYLATE CEMENT
 Polycarboxylate cements evoke a pulpal response similar to that caused by ZOE,
with a slight-to-moderate response after 3 days and only mild, chronic
inflammation after 5 weeks.

 Reparative dentin formation is minimal with these cements, and thus they are
recommended only in cavities with intact dentin in the floors of the cavity
preparations.
ZINC OXIDE EUGENOL CEMENT
mice
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
DENTAL CERAMICS
Bleaching agents
 These agents usually contain some form of peroxide (generally carbamide
peroxide) in a gel that can be applied to the teeth either by the dentist or at home
by the patient.

 The agents may be in contact with teeth for several minutes to several hours
depending on the formulation of the material.

 Home bleaching agents may be applied for weeks to even months in some cases
 In vitro studies have shown that peroxides can rapidly (within minutes) traverse
the dentin in sufficient concentrations to be cytotoxic.

 But the cytotoxicity depends to a large extent on the concentration of the

peroxide in the bleaching agent

 Peroxides rapidly even penetrate intact enamel and reach the pulp in a few
minutes.

 Tooth sensitivity is very common with the use of these agents

IMPRESSION MATERIALS
 Addition Silicone
 Hydrocolloids NONTOXIC
 Polysulphides - contain lead peroxide, among others, which can
cause acute and severe systemic toxic effects when swallowed or
inhaled
 Polyether
 ZnoE ALLERGIC REACTIONS

 least biocompatibility applies to condensation silicones

precautions
 Direct and repeated skin contact by dental personnel, however, should
be avoided.

 Contact with the eyes, which may happen when mixing a liquid catalyst
into a putty impression material by hand, should also be avoided, such
as by wearing protective glasses or by using a paste catalyst.

 It is important for the subgingival area of the sulcus to be carefully

controlled for remnants of impression material, particularly in patients
with deep periodontal pockets.
POLY-METHYLMETHACRYLATE
RESINS
 Denture base materials:

MMA Monomer is the main cause for hyper sensitization

 Hypersensitivity has been documented to the acrylic

and diacrylic monomers, certain curing agents,
antioxidants, amines, and formaldehyde

 For the patients most of these materials have been

reacted in polymerization and thus are less prone

 Two aspects are of particular importance: monomer–

polymer conversion and residual monomer content.
 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, oedema &

occasionally small vesicles and erosions

 Heat polymerized is better than Auto polymerized resin

 Dentist suffering from an allergy to
methyl methacrylate contact
dermatitis

 Pronounced inflammation of the

palatal mucosa beneath a
polymethyl methacrylate denture
with papillary hyperplasia
 SOFT DENTURE LINERS & ADHESIVES
 Release of plasticizers

 Extremely cytotoxic

 Denture adhesives show severe cytotoxic reactions in-vitro

 Large amount of formaldehyde

 Allowed significant microbial growth

REACTION OF BONE & SOFT TISSUES TO IMPLANT
MATERIAL

A) REACTION TO CERAMIC IMPLANT MATERIAL

 VERY LOW TOXIC EFFECTS.
 OXIDIZED STATE CORROSION RESISTANT
B) REACTIONS TO RESORBABLE MATERIALS

 Well-tolerated by tissues in vivo

 Resorbability of these materials depends on the volume of material implanted
and because these materials degrade into acidic byproducts which may
invoke an inflammatory response.
 E.G. Co-polymer of polylactic acid (PLA) and polyglycolic acid (PGA), natural
polymers such as cross-linked collagen, starch, and cellulose.
 Used for resorbable sutures, fracture fixation plates and screws, guided tissue
membranes, and controlled drug-release systems
REACTION TO PURE METALS &
ALLOYS
 ‘Metal’ is oldest type of oral implant material
 Initially selected on the basis of the ‘ease of fabrication’
 Stainless steel, chromium-cobalt- molybdenum, titanium
and its alloys
 Most commonly used is titanium(Ti-6Al-4V)
 Titanium’s biocompatibility is associated with its fast
oxidizing capacity. Corrosion resistant & allows
osseointegration
SOFT TISSUE

 Epithelium forms a bond with implant

similar to that of tooth
 Connective tissue apparently does not
bond to the titanium, but forms a tight
seal that seems to limits ingress of bacteria
& its products
In recent years, Titanium allergy has been
noted at a low prevalence rate of 0.6% and
presents with urticaria, eczema, redness of
the mucosa.
 Recent reports have questioned whether metal sensitivity may occur after
exposure to titanium.

 This clinical report demonstrates the emergence of facial eczema in association

with a titanium dental implant placed for a mandibular overdenture supported
by 2 implants.

 Complete remission was achieved by the removal of the titanium material.

 This clinical report raises the possibility that in rare circumstances, for some
patients, the use of titanium dental implants may induce an allergic reaction.
Facial eczema Ten months after removal of
dental implants
a b

Oral photographs of patient before and 10 months after removal of

dental implants
A, Edentulous maxillary arch. B, Edentulous mandibular arch
BARRIER MATERIALS
 Latex :

1.The incidence of latex allergy is about 9.7% and 6% among patients

and dental staff, respectively.

2.Latex products can produce either:

 Type 1 immediate atopic/anaphylactic reaction - due to proteins present in natural

latex

 Type 1V delayed hypersensitivity reaction (allergic contact dermatitis): due to

accelerators and antioxidants used in latex manufacturing
 Precaution to be taken are
as follows
Non latex synthetic materials such as nitrile and styrene ethylene butadiene styrene should be used.
Polyethylene or polyvinyl chloride rubber dams can be used instead of latex

Contact urticaria following severe irritative hand dermatitis

occupational exposure to (non allergic) caused by
frequent hand washing and
latex proteins in disposable gloves wearing of disposable gloves
CLINICAL GUIDELINES FOR SELECTING BIOCOMPATIBLE
MATERIALS

 Define the Use of the Material

 Define How the Material Has Been Tested
 Think in Terms of Risk and Benefit
SUMMARY
CONCLUSION
 Due to rise in number of patients with allergies from different materials, the
practicing dentists should be aware about the allergies documented to known
materials

 for establishing diagnosis, it is essential to obtain proper history related to allergy,

clinical examination and confirmatory tests.

 It is mandatory for the clinician to know and understand the biocompatibility of

the dental materials, so as to provide maximum advantage & minimum risk to the
patient.
REFERENCES

 Restorative dental materials (13th edition) – G. Craig & John H.

Powers
 PHILLIPs’ Science of dental material (12th edition)
Thank you