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Ministry of Health of Ukraine Ukrainian Medical Stomatological Academy Ministry of Health of Ukraine Ukrainian Medical Stomatological Academy APPROVED at the meeting of the Department of Paediatric Therapeutic Dentistry with Dental Diseases Prevention Minutes No. 1 as of 28.08.2020 Head of the Department Prof. Kaskova L.F. Methodological instructions №8 for independent work of students in preparing for in-class activity Academic discipline Propaedeutic of Paediatric Therapeutic Dentistry Module №1 Propaedeutic of Paediatric Therapeutic Dentistry Theme of class Dental cements and amalgam. Composite resins and compomers. Technique of the I and V caries class cavities filling in primary and permanent teeth Year of study 2 Faculty Foreign Students Training Poltava 1. Relevance of the theme: Fillings prevent bacteria or plaque from building up inside cavities, which could lead to serious infections. They also reinforce the tooth, to keep it from chipping, cracking, or breaking inward from trauma. Without a filling, even minor cavities could seriously compromise the health and function of your teeth. Filling of carious cavities is a basic skill of future dentist. 2. Specific aims: To know algorithms of filling of the 1 and 5 class carious cavities in primary and permanent teeth with different filling materials. To be able to demonstrate on the phantom filling of the 1 and 5 class carious cavities in primary and permanent teeth with different filling materials. 3. Basic knowledge, skills, abilities needing to study the theme (interdisciplinary integration) The names of the The acquired knowledge or skills preceding disciplines Anatomy Describe anatomy of permanent and deciduous teeth. To distinguish the features of structure of enamel and dentin in Histology permanent and deciduous teeth. Terms of eruption, histogenesis, mineralization of the permanent and deciduous teeth Propaedeutic of To describe filling materials: classification, indications, therapeutic dentistry technique of application. 4. The tasks for independent work during the preparation to the class and in the class time 4.1. The list of basic terms, parameters, characteristics, which the student should learn during preparation to the class Term Definition Temporary filling While some types of fillings can be placed the same day that tooth decay is removed, others take time to manufacture. When this is the case, a temporary filling will need to be placed. Temporary fillings are made with less durable material, so it’s important to take proper care of them while the finished filling is being produced Liner Thin layer of filling material which put on bottom of caries cavity to protect pulp 4.2. The theoretical questions to the class: 1. The main requirements for permanent filling. 2. Characteristic of silver amalgam. 3. Characteristic of glass ionomer cements (GIC). 4. Temporary filling materials. 5. Which filling materials are used as liners? 6. Characteristic of phosphate cements. 7. Technique of the filling of the 1 class with amalgam. 8. Technique of the filling of the 5 class with GIC. 9. Technique of the filling with artificial dentin. 4.3. Practical tasks made in the class time 1. Fill 1 class cavity on phantom with artificial dentin. 2. Fill 5 class cavity on phantom with GIC. 3. Fill 1 class cavity on phantom with Adhesor. 5. The content of the topic. Classification of filling materials Groups of filling materials: 1. Temporary sealants. 2. Permanent sealants. 3. Liner. 4. Root filling. 5. Fissure sealants. I. Temporary filling: 1. Artificial dentin; 2. Dentin-paste; 3. Vinoxol; 4. Zinc oxide-eugenol cement (ZOE); 5. Polycarboxylate cement. II. Permanent filling: 1. Cements (D.S. Smith,1995): a) phosphate cement: - zinc phosphate -silicate phosphate b) phenolate: - zinc oxide-eugenol cement (ZOE); -calcium hydroxide; c) polycarboxylate cement; - zinc-polycarboxylate; -glass ionomer cement; d) acrylic: -polyacrylate - dymetylacrylate 2. Amalgam: - silver; - copper; - gold; - gallodent – M. 3. Composite filling: a) the particular of polymerizing composite: - chemically polymerized composite resin; - visible – light –polymerized composite resin; - dual – cure (chemically and light) polymerized composite resin. b) the features of filling: - microfill (sample Silux Plus); - macrofill; - hybrid filling: macro hybrid filling (Spectrum) micro hybrid filling, c) – fluidity filling (faintly filling); - strongly filling. D. Inlays 5. Fissure sealants. Сements Zinc Phosphate Zinc phosphate cement is composed of zinc oxide and magnesium oxide powder that is mixed with a solution of phosphoric acid and water. The zinc oxide alkaline surface reacts with the phosphoric acid to form a cement of zinc phosphate surrounding particles of zinc oxide. The addition of aluminum and zinc ions buffers the solution to slow the setting reaction. Mixing the cement on a cooled slab minimizes heat production during the chemical setting and increases the working time. When using zinc phosphate cement as a base, additional zinc oxide powder is placed in the mixture to provide a thick consistency, increasing the strength and decreasing the hardening time of the cement. Zinc phosphate cement (also called zinc oxide phosphate) is prepared by mixing a powder and liquid on a glass slab with a spatula. Two different mixes are used: a thick mix of putty consistency and a thin creamy one. Setting takes a few minutes depending on various factors: 1. A warm slab accelerates the setting while a cold slab has the opposite effect. 2. A thick mix sets more quickly than a thin mix. 3. A dry slab must be used as moisture accelerates setting. It is most important to screw the cap on tightly, immediately after using the bottle of liquid, to prevent it absorbing moisture from the air. If this happens, the cement will set too quickly. 4. If a long setting time is required, when cementing a bridge, for example. a cold slab is necessary. A tiny quantity of powder is mixed with the liquid a minute or so before the cement is required. The rest of the powder is then added in small quantities at a time. This ability to prolong its setting time is the overriding advantage of zinc phosphate cement. A cool thick glass slab should be used for mixing zinc phosphate cement. Thin slabs are warmed by the nurse's hand and can make the cement set too quickly. Uses A thick mix sets rapidly and is used as a temporary filling and cavity lining; and also to block out undercuts in crown or inlay preparations. As it is so adhesive, instruments used for inserting and manipulating it in a cavity are dipped in alcohol beforehand to prevent cement sticking to them. A thin mix sets more slowly and is used to cement inlays, crowns, bridges and orthodontic bands into place. Advantages The advantage of this cement is that it sets very hard in a few minutes and therefore makes a sound lining for permanent fillings: and a durable temporary filling. Furthermore, its adhesive nature makes it satisfactory for cementing (luting) prefabricated restorations. Disadvantages In deep cavities it is irritant, and in these cases a sublining of calcium hydroxide is inserted before the zinc phosphate cement. Otherwise a different lining must be used. Zinc phosphate cement will not adhere to a damp cavity. Unless saliva can be kept away, the lining will fail. Polycarboxylate cement Polycarboxylate cement (for example Durelon) is prepared by mixing powder and liquid with a spatula on a glass slab or paper pad. The powder consists mainly of zinc oxide; the liquid is polyacrylic acid. Many cements using polyacrylic acid have introduced replacement of the liquid by water. Polyacrylic acid, which is the normal liquid component, is dehydrated and included with the powder instead. The cement is then prepared by simply mixing the powder with water in the normal way (for example Poly-F Plus). The advantage of this anhydrous system is that only one bottle of material is needed; and there is no liquid to deteriorate, or to be used up too soon, or left over when the powder bottle is empty. Furthermore the normal liquid is rather viscous, difficult to dispense from the bottle and difficult to mix. Mixing with water is much easier and quicker. Polycarboxylate cement may be prepared as a thin mix for cementing, or thick mix for lining. A measure is supplied by the manufacturer for dispensing correct amounts of powder. Instruments are dipped in alcohol or dry cement powder to prevent cement sticking to them; and are easier to clean afterwards if they are washed in water before the cement sets. Uses It is an alternative to zinc phosphate cement. Advantages It is less irritant than zinc phosphate cement and far more adhesive. For these reasons many operators prefer it to zinc phosphate for cementing inlays, crowns and orthodontic bands. Disadvantages It can be rather difficult to manipulate as it is so adhesive. Glass ionomer Cement Glass ionomer cement (GIC), also known as glass polyalkenoate, consists of a powder and liquid which are mixed together on a paper pad. The powder is a glass-like mixture of aluminosilicates. The liquid contains polyacrylic acid (or polymaleic acid) and is similar to polycarboxylate cement liquid. Calcium hydroxide linings are unnecessary unless the cavity is very deep. Uses GIC has many different uses which depend on three outstanding properties: 1. It releases fluoride and thereby prevents the recurrence of caries in and around the cavity. 2. It bonds directly to enamel, dentine and cementum without acid etching. This chemical bond to tooth substance means that undercuts are not essential and makes it suitable for filling unretentive cavities; fissure sealing; a dentine substitute for restoring the excessive loss of tooth substance; and as an adhesive cement for inlays, crowns and orthodontic bands. 3. It can itself be acid etched. This allows it to be used as a retentive lining for composite fillings. GIC is not strong enough for filling cavities which are exposed to the full force of mastication.
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