DM FINAL PPT.pptx including all the recent advances

Dental materials play a fundamental role in the rehabilitation of tooth structures and regeneration of oral tissues. In the last years, technological development played a key role in the field of dental materials, introducing the engineered materials. These materials exhibiting a “smart behavior“ generated a new era that helps the dental materials to respond to stimuli by altering one or more of their properties without compromising the protection of tooth and oral tissues [1,2]. Likewise, the materials intended for prosthetic restorations were provided with an innovative structure on micro-nano-scales. Similar structural characteristics belong to materials like Zirconia, lithium disilicate or the Zirconia-Lithium-silicate. Some argue that in dental materials it is toughness that is required, not strength or hardness. In this respect, considering also the low adhesive values in cementation, and despite the wide clinical use, zirconia seems to be inadequate. So where are we going? all the more so, the zirconia, with its characteristics of chemical inertia, fails to have an adequate etchable surface when compared with the values obtained with glass ceramics. To overcome these limitations, primers containing 10-methacryloyloxydecyl dihydrogen phosphate (10 MDP) have been developed and introduced in dentistry whose clinical effectiveness remains to be confirmed. To address this issue, Valente et al. [3] have evaluated, in an original article, the resistance values of adhesive cementation of zirconia discs prepared for the clinical use thickness, with different resin-cement added or not with the 10 MDP. The 10-MDP was effective to improve the bond strength between resin-cement and zirconia. Clinically, this new generation of dental materials needs to be validated to enable prediction of long-term results. In this regard, a valuable study was performed by Brandt et al. [4], which reported a 5-year cumulative survival rate of 94.22% obtained on a total of 1058 full-coverage crowns made of IPS e.max Press, IPS e.max CAD, IPS e.max Ceram or IPS e.max ZirPress.The conventional dental materials have been acquisitive for long, which means they were developed elsewhere for different purposes, and following the principles of ‘adopt, adapt, improve’, sometimes with idiosyncratic and personal recipes of individual practitioners, have been introduced in clinical practice. The evolution and exponential diffusion of digital technologies allowed the development of special materials to be used for CAD/CAM systems. These materials with a digital vocation are more “sophisticated” than those used in analogue techniques. Usually, they are available in partially crystallized form to be milled, after that they must undergo thermal treatment to reach the final crystallization at a well-defined temperature for an exact time, as indicated by manufacturers. Crystallization is an important step performed in the laboratory by dental technician in an oven. Regarding this aspect,

1. RECENT ADVANCES IN DENTAL MATERIALS PRESENTED BY : Mansi Agarwal ( JR1 ) SUPERVISED BY : Prof Shaista Afroz and Dr Sabzar Abdullah

2. CONTENTS PAGE .1 ADVANCEMENT IN IMPRESSION MATERIALS Alginate , elastomers .2 ADVANCED WAXES , .4 IMPLANTS AND MAXILLOFACIAL MATERIALS .3 MISCELLANEOUS MATERIALS, BONDING AGENTS COMPOSITES AND DENTURE BASES

3. Drawbacks of conventional alginates : Poor dimensional stability ( imbibition and syneresis ) Low tear strength Silica dust in the form of diatomaceous earth Poor tray adhesion NEWER ALGINATES

4. Dustless Alginates The material is coated with polyethylene or polypropylene gycol , makes the material dense and dust inhalation is reduced while manipulation. Two paste system Alginates To avoid powder contamination and inconsistency in dispensing a specific amount of powder.

5. Chromatic alginate To distinguish the different stages of manipulation , various color indicators were applied to the alginate impression materials . These colour indicators change the color of the alginate mix as the pH changes, causing the setting reaction to occur. The alginate mix’s colour changes, making it easier to determine the perfect consistency for loading it into the tray and making accurate impressions. Tray Adhesive Alginate Liquid and spray containing polymide or diethylenetriamine polymer , Ester gum and rosin in iso propyl alcohol has been introduced.

6. Self-disinfected Alginates Addition of disinfecting agents into the impression materials eliminates separate disinfection of the impression immediately after removing it from the patient‘s mouth . Alginate with polyacrylamide incorporation The addition of a thickening and stabilizing agent , such as 0.01–0.25 weight percent polyacrylamide to traditional alginates improved mixing characteristics and the creation of smooth alginates.

7. Extended pour Alginates Long dimensional stability (168 hours ) High accuracy Manufactured by LASCOD (Italy) STORING - Impression must be stored in safe lock bags. Its working time can be extended when required by adding krono personal liquid. Every drop of personal krono – 20 sec.

8. NEWER ELASTOMERIC IMPRESSION MATERIALS

9. Vinyl Polyether Siloxane (VPES) Shetty RM, Bhandari GR, Mehta D. Vinyl polysiloxane ether: a breakthrough in elastomeric impression material. World J Dent. 2014 Apr;5(2):134-7. Vinyl siloxanether is an impression material that is made by combining the properties of polyether and addition silicone . In addition to the hydrophilicity of polyether , it also provides the high elastic recovery of addition silicone. These features make this material promising for tough situations like that of moisture control .

10. HYDROPHILIC POLY VINYL SILOXANE Conventional polyvinyl siloxane was hydrophobic in nature and hence proper moisture control is required to obtain an acceptable impression. This new material has been advertised as hydrophilic material , which means that they can work in a humid environment like that of the oral cavity. This is due to the presence of intrinsic surfactants that improve the wettability and facilitate fabrication of gypsum materials. Aquasil Ultra LV Light Body

11. FAST-SET ELASTOMERIC MATERIALS For the reduction of chair time and the provision of fast means of impression fabrication. Thiol-ene functionalized siloxane are prepared and evaluated for use as a rapid set elastomeric impression material . It records the surface details at both gross and fine level.

12. Photo-initiated elastomeric impression material This material is Polyether urethane dimethacryclate . The photo initiated impression material is supplied premixed as a light-bodied material in a light-tight plastic syringe and as a heavy-bodied material in a tube. ADVANTAGES Long working time but short setting time Impressions can be corrected Dimensional stability , flow and detail reproduction is good . DISADVANTAGES Expensive and requires special equipment

13. NEWER DENTAL WAXES

14. Light cured wax ( METACON) I deally combines waxes, acrylics and photo- polymerising elements. Thus the material handles like wax before - and like acrylic after light curing. A vailable as modelling wax & as preformed patterns No need for duplicating materials C an be trimmed before investing

15. burns out cleanly and completely D oes not show any shrinkage or distortion after curing The material is strong yet flexible P olymerized Metacon wax has a memory

16. Aesthetic Waxes Keystone AFG aesthetic translucent waxes, created by Alberto Battistelli , are used to construct wax teeth that faithfully reproduce natural teeth with a layering system similar to that used by prosthodontists for dental ceramics. The pastel coloration with light shades is very similar to dentine and natural enamel and is accompanied by slightly brighter colors. This reproduces individual characterization in a way that is similar to what is normally done with super-colors or intensive masses during the construction of ceramic teeth.

17. SCAN WAXES CAD/CAM Yeti CAD/CAM Scanning Wax is an economical scanning wax that is a laser and light opaque modeling wax. Specially used for CAD/CAM technology and guaranteed best scan and fitting results.

18. NEWER GRINDING , FINISHING AND POLISHING MATERIALS

19. Air-Particle Abrasion Technology As an alternative to the use of rotary instrument, air particle Abrasive systems are minimal invasive technologies that can deliver a definitely controlled high - pressure fine stream of 25 μ m to 30 μ m aluminium oxide or silica particles to remove decayed or stained enamel, dentin, and restorative materials. Nanotechnology Liquid Polish This new paint - on - polish adds a smooth, dazzling finish to any composite or temporary restoration.

20. Profin PDX System C omprises of a contra-angle hand piece using reciprocal motion with special finishing and polishing tips - Lumineers LTA ( Dentatus AB,Sweden ). This system is mainly indicated for elimination of overhangs, contouring, grinding , and smoothening of restorations particularly in the sub-gingival and interproximal regions.

21. NEWER GINGIVAL RETRACTION METHODS

22. Expasyl Expasyl is a biocompatible material which presents with advantages of having excellent retraction with longer shelf life. It is known to physically displace the tissue for better marginal access. Minimal pressure required to displace the tissues. It does not pose hazard of rupturing epithelial attachment. It also produces haemostasis and controls crevicular seepage.

23. Magic Foam cord Magic foam cord is a polymeric material which is introduced into the gingival sulcus and allowed to set. Magic Foam cord presents with efficient haemostasis and minimal damage to tissues while retraction .

24. Gingitrac GingiTrac uses an auto mixing gun to deliver the perfect combination of mild built-in astringency to control haemostasis . TissueGoo Tissue Goo is a gel that contains active ingredient is 25% aluminium sulfate stays put where it is placed and provide sample haemostasis during tissue retraction. Retraction Capsule The recently introduced 3M ™ESPE ™ Retraction Capsule is 15% aluminium chloride retraction paste.

25. Adhesive material with anti-matrix metalloproteinase functions On the application of MMPs inhibitors as components of the adhesive system, a bond system is provided with improved durability of the adhesive restoration. It can incorporate DOXYCYCLINES , ALCOHOLS or Collagen cross linking agents . NEWER BONDING AGENTS

26. Antibacterial bonding system ( silver nanoparticles ) The addition of antibacterial primer can help to kill residual bacteria in the tooth cavity; Zinc Doped Adhesives Zinc doped adhesives can be obtained by using 20wt%ZnO or 2wt% ZnCl2 without altering adhesive physical , chemical and mechanical properties. zinc doping improves sealing efficacy and dentin remineralization .

27. NEWER RESIN BASED COMPOSITES

28. Nanocomposites Nanotechnology may provide composite resins with a dramatically smaller filler particle size that can be dissolved in higher concentrations and polymerized into the resin system. Antimicrobial Composite Silver or one or more antibiotics into the material. Microbes are subsequently killed on contact with the materials or through leaching of the antimicrobial agents into the body environment.

29. Stimuli Responsive Composite Properties that may be considerably changed in a controlled fashion by external stimuli. Such stimuli may be for example changes of temperature, mechanical stress, pH, moisture, or electric or magnetic fields.

30. Organically modified ceramic oligomers (ORMOCER) They are considered to be molecule-sized hybrid structures consisting of inorganic, organic copolymers. They include; limited cure shrinkage, very high biocompatibility, good manipulation properties, and excellent aesthetics.

31. Ion releasing composites Also known as smart composites , release calcium ,fluoride and hydroxyl ions depending on the pH change on the restoration surfaces. Consequently, with an increase in the ions expressed, it was aimed to prevent the effect of bacteria, the buffering capacity and the formation of secondary decay which develops at the edges of the restoration.

32. Proline -containing GIC It is an amino acid– containing GIC, which has better surface hardness properties . Calcium aluminate GIC A hybrid product with a composition between that of calcium aluminate and GIC, The calcium aluminate contributes to a basic pH during curing, reduction in microleakage , excellent biocompatibility, and long-term stability and strength. ADVANCES IN DENTAL CEMENTS

33. Ceramir Crown & Bridge Permanent, radiopaque, bio ceramic luting cement. The capsules contain glass ionomer powder and bio ceramic (calcium aluminate) powder plus water. Activation of the capsule with the Ceramir Activator is done prior to mixing in a 4000- 5000 rpm mixer. Dispensing requires use of either the Ceramir Applicator, Aplicap Applier (3M ESPE) or the AC Applicator (VOCO).

34. NEWER DENTURE BASE RESINS

35. PMMA has all the properties essential for ideal denture base material except mechanical properties. PMMA is not only material of choice for denture bases but also for denture reliners , rebases, maxillofacial prosthesis, orthodontic prosthesis, temporary crown, splints for surgical procedures. Remarkable esthetics , well defined fabrication, and processing methods, ease of repair, easy availability and low cost. Moreover, its coral pink color resembles the natural color of mucosa. Despite all positive aspects, PMMA is not devoid of shortcomings. 1. Poor strength 2. Allergic reaction To improve the poor strength of PMMA, several materials have been used to reinforce PMMA which resulted in improved flexural strength , impact strength and fatigue resistance.

36. Reinforced resins High impact resins Rubber reinforced (butadiene-styrene polymethyl methacrylate). Rubber particles grafted to MMA for better bond with PMMA. They are so-called because of greater impact strength & fatigue properties, hence indicated for patients who drop their dentures repeatedly e.g., parkinsonism, senility.

37. Addition of glass fibers to acrylic denture base material is an effective way of increasing flexural strength, impact strength and toughness . b) Glass Fiber Reinforced Resins

38. c ) SALINIZED ZIRCONIUM OXIDE Reinforcement of acrylic denture base material with zirconia (ZrO2) has a significant impact on mechanical properties of denture base material. It resulted in increased flexural strength and impact strength of acrylic resin. Hardness and surface roughness increased slightly when salinized zirconia NPs were incorporated in acrylic resin, while apparent porosity (SEM analysis) , water sorption and solubility decreased.

39. d) TO PREVENT MICROBIAL COLONIZATION IN DENTURE BASES Polymethyl methacrylate is susceptible to microbial colonization which eventually leads to denture-related diseases like stomatitis. PMMA has inner rough surface that predisposes to microbial colonization. In recent years, research is more focused on the modification of polymethyl methacrylate to improve its surface properties and resistance to bacterial and fungal infections.

40. ZnO -NPs have high hydrophobicity , hardness, and absorbability that prevents adhesion of microorganisms to denture bases . 1. ZINC OXIDE NANOPARTICLE S 2 . SILVER NANOPARTICLES It has been observed through studies that the Ag-NP acrylic base has more antifungal properties than acrylic bases. Biomass adherence of Candida albicans on denture bases have significantly decreased .

41. FLEXIBLE REMOVABLE PARTIAL DENTURES Dentures fabricated with PMMA usually have difficulty fitting in deep undercuts . Flexible partial dentures are used in cases where there is, bilateral undercuts , tilted tooth forming an undercut, patient allergic to acrylic resin denture bases For Clinicians, it is less time taking and less complex technique and easily adapted thermoplastic nylon have superior esthetics due to its translucency

42. Valplast is a flexible denture base resin that is ideal for partial dentures and unilateral restorations. The resin is a biocompatible nylon thermoplastic with unique physical and aesthetic properties that provides unlimited design versatility and eliminates the concern about acrylic allergies.

43. A major drawback of thermoplastic nylon flexible denture is the requirement of different processing and insertion technique hence fabrication needs special training. There is a lack of mechanical bonding with denture teeth. Special equipment and instruments need to be purchased in order to adjust the flexible denture . Hence, It’s not cost effective . As the name suggests flexible denture fails to maintain the vertical dimension under occlusal forces due to flexibility .

44. Sunflex Sunflex Partial Dentures are made from a strong biocompatible nylon thermoplastic, and are unbreakable, yet lightweight and translucent which allows natural tissue to show through.

45. Titanium as denture framework material In the late 20 th century, titanium and titanium alloy have been preferred as a denture base framework material in cast partial dentures Superior biocompatibility Low density Superior mechanical properties Corrosion resistance.

46. Porcelain and zirconia-based denture framework It has only been a decade since the introduction of zirconia restoratives and its popularity and success is significantly increased. Because of its excellent compatibility, mechanical characteristics and considerably simple manufacturing procedure i.e., CAD/CAM. Titanium and Zirconia are rising as alternatives to conventional fixed prosthesis metal framework.

47. ACRYLIC DENTURES relative ease of production and affordability improving the aesthetic outcomes for patients BUT While initially fitting well, the material tends to deteriorate over time, leading to fit issues that require readjustment or complete replacement . This wear and tear could lead to discomfort, with patients often experiencing sore spots or difficulty chewing . Furthermore, acrylic dentures required rigorous maintenance, as they were prone to staining and retaining odors, necessitating meticulous cleaning routines.

48. CAD/CAM Milled Dentures CAD/CAM milling removes the denture from a solid block of the chosen material, ensuring uniformity and a bespoke fit.  Nowadays, CAD/CAM milling for complete denture fabrication has become commercially available with the introduction of  AvaDent digital dentures , the  Polident CAD/CAM dentures , and   Ivotion by Ivoclar . 

49. 3D Printed Dentures On the other hand, 3D printing is a marvel in its own right. 3D printing has the capability of constructing dentures layer by layer. This ensures an exacting precision that is hard to achieve consistently through traditional methods.  Dentca Denture Resin from Whip Mix  is the first 3D-printed resin to receive FDA clearance. Their physical properties and biocompatibility pass FDA requirements and give printed denture properties similar to conventional ones. The Dentca 3D printable resins include an ivory-colored try-in material, tooth materials in Vita shades A1, A2, A3, A3.5, B1 & B2, and denture base materials in Original Pink, Light Pink, Reddish Pink & Dark Pink shades. 

50. Formlabs Denture Resin Flexcera Dental Resin Kulzer’s dima Print Digital Denture

51. SprintRay High Impact Denture Solution Rodin Denture Base

52. NEWER DENTAL IMPLANTS

53. Accioni F, Vázquez J, Merinero M, Begines B, Alcudia A. Latest trends in surface modification for dental implantology : Innovative developments and analytical applications. Pharmaceutics. 2022 Feb 21;14(2):455. Graphical overview of the review.

54. The biocompatibility, osseointegration and therapeutic/antibacterial effect of the implant coating have been considered to be the most important factors for the long-term durability of dental implants. Various bioactive materials and local drug delivery techniques have been explored. These novel coatings have been divided into two groups, depending on the nature of the material applied i.e., organic and inorganic coatings.

55. Advances in dental implant materials Graphene Nanocomposites Unprecedented Strength and Flexibility: The integration of graphene, a two-dimensional carbon structure, into dental implant materials has ushered in a new era of strength and flexibility. Graphene’s remarkable mechanical properties contribute to implants that can withstand the dynamic forces within the oral cavity.

56. Zirconia Implants Aesthetic Elegance and Biocompatibility: Zirconia implants have gained prominence for their natural tooth-like appearance and biocompatibility. 3D-Printed Implants Precision Redefined: The advent of 3D printing technology has revolutionized the customization and precision of dental implants. This innovation allows for implants that are tailored to match the unique anatomy of each patient, contributing to improved fit and success rates.

57. Smart Implants Real-Time Monitoring and Feedback: Smart implants, equipped with sensors and monitoring capabilities, provide real-time feedback on various parameters during the healing process. This innovation enhances patient care and allows for proactive intervention when needed. Genetically Engineered Implants Tailored for Success: Genetically engineered implants involve modifying the implant surface at a genetic level to optimize its interaction with the surrounding tissues. This personalized approach aims to enhance the predictability and success of dental implant procedures.

58. Poly-ether-ether-ketone (peek) PEEK is a high performance semi-crystalline thermoplastic polymer. very good strength and stiffness with an outstanding thermal and chemical resistance—e.g., against oils and acids. Also, the colourless and elastic modules nature makes it resemblance to bone. However, the limiting factor being disturbed osteointegration .

59. Tantalum implants Its property of being corrosive resistant and better osseointegration has led to emergence of its use in the implants. Production of porous tantalum trabecular metal ( pttm ) -The porous tantalum trabecular metal as the name suggests has high volumetric porosity, high frictional characteristics and low modulus elasticity.

60. One-piece implants Abutment and implant body are in one piece and not separate. They are commercially available in 3 mm diameter and 12, 15, and 18 mm length. Maximum strength – It is one-piece, titanium alloy construction provides maximum strength, while its 3.0 mm diameter allows placement in areas of limited tooth-to-tooth spacing. Minimal surgery – Because one-piece implants are placed using a single-stage protocol, the soft tissue experiences less trauma than typical two-stage protocols with maximum aesthetics.

61. LIGAPLANT This technology is nothing but combination of the PDL cells with implant biomaterial. Currently research is going on in making this implant a noble one. Liga plants has certain properties like: PDL cells act as a soft, richly vascular, and cellular connective tissue which permits forces elicited during masticatory function and other contact movements to be distributed to the alveolar process via alveolar bone proper. It act as a, shock absorber giving the tooth some movement in the socket. 3. It provides Proprioception.

62. Bathla N, Sailo JL, Kapoor N, Nagpal A, Gupta R, Singla A. Ligaplants, the next-generation prosthodontic implants: A comprehensive review. Indian Journal of Dental Sciences. 2021 Apr 1;13(2):146-9.

63. NEWER MAXILLOFACIAL MATERIALS

64. Silicone Block Co Polymers Silicone block copolymers are new materials to improve some of the weaknesses of silicone elastomers , such as low tear strength low – percent elongation the potential to support bacterial or fungal growth This is achieved by a surface modification consisting of the incorporation of block copolymers of polydimethylsiloxane (PDMS)

65. Polyphosphazenes Polyphosphazenes fluoroelastomer has been developed for use as a resilient denture liner and has the potential to be used as a maxillofacial prosthetic material. Researchers in New Orleans dealt with maxillofacial prosthesis, have found that compounding polyphosphazenes with little or no fillers and decreasing the ratio of acrylic to rubber yields a softer rubber, with a HDA of 25, similar to human skin.

66. Foaming Silicones F irtell et al. introduced foaming silicone for fabrication of light weight prosthesis . When silicone is mixed with stannous octoate catalyst , releases a gas in the vulcanization process as bubbles are released with the resulting silicone mass being increased and density being decreased, which presents a much lighter material . The mold also requires venting for gas release and reduction of expansion of the prosthesis . The purpose of the foam forming silicones is to reduce the weight of the prosthesis.

67. Siphenylenes - Lewis and Castleberry described the potential use of Siphenylenes for facial prostheses. Siphenylenes are siloxane copolymers that contain methyl and phenyl groups. They are formulated as a pourable, viscous, room-temperature vulcanizing liquid. These polymers are transparent even when reinforced with silica fillers .

68. Dentistry continues to evolve toward bright future with the innovations and development of new materials, techniques, and equipments . These material advancements are directly related to laboratory adoption of digital technology . The significance of accurate and esthetically pleasing dental materials in completing the digital link cannot be overstated. By utilizing better workflow solutions, laboratories have been able to offer new and innovative products to their clinicians. Conclusion

69. REFERENCES : 1. Sharma S, Dhruvakumar D. Recent trends in implant dentistry: A mini-review. Tanta Dent J 2018 2. Saeed F, Muhammad N, Khan AS, Sharif F, Rahim A, Ahmad P, Irfan M.Prosthodontics dental materials: From conventional to unconventional. Mater Sci Eng C Mater Biol Appl. 2020 Jan 3 . Maxillofacial prosthetic materials: current status and recent advances: A comprehensive review, 4. Leung, G.K.-H.; Wong, A.W.-Y.; Chu, C.-H.; Yu, O.Y. Update on Dental Luting Materials.Dent. J. 2022 5. Hong DGK, Oh JH. Recent advances in dental implants. Maxillofac Plast Reconstr Surg. 2017 Nov 6. Bathla N, Sailo JL, Kapoor N, Nagpal A, Gupta R, Singla A. Ligaplants, the next-generation prosthodontic implants: A comprehensive review. Indian Journal of Dental Sciences. 2021 Apr 1;13(2):146-9. 7. Dong, H.; Liu, H.; Zhou, N.; Li, Q.; Yang, G.; Chen, L.; Mou, Y. Surface Modified Techniques and Emerging Functional Coating of Dental Implants. Coatings 2020 8.Bathala L, Majeti V, Rachuri N, Singh N, Gedela S. The Role of Polyether Ether Ketone (Peek) in Dentistry - A Review. J Med Life. 2019 Jan-Mar