Biocompatiblity of dental

materials
 Contents
• Definition
• Introduction
• Adverse effects of dental material
• Local and systemic effects
• Relevance
• assessment
• Regulatory bodies
• Current biocompatibility issues
 definition
• Biocompatibilty:-Defined as the ability of
material to elicit an appropriate biological
response in a given application in the body
• Biocompatible:-capable of existing in harmony
with surrounding environment
 biocompatibility

patient

Material
material
function
 color biocompatibilty

Source
host
of light

material material

Application of
observer material
 Biocompatibility depends on
• Chemical nature
• Physical nature
• Type and location of patient tissues
• Duration of exposure
• Surface characteristics
• Amount and nature of eluted substances
 Enamel

• 96% -Inorganic
• 3%-water
• 1%-organic molecules-amelogenins &
enamellins
• Permeabilty is low-”seals”
 Dentin and pulp
• 70% -inorganic
• 20%-organic(collagen and non collagenous
proteins)
• 10%-water
• Dentin matrix protein
• PULP - 20% Organic
85% collagen
 DENTIN & PULP
• Dentinal tubules are surrounded by dentinal matrix
• Tubules contain odontoblastic processes
• These processes traverse the DEJ & pulp
• Tubules from C.S area range from 20,000/mm² near
DEJ to 50,000/mm² near the pulp.
• Tubule diameter varies from 0.5µm at DEJ to 2.5 µm
near pulp
• Pulpal circulation maintains the intercellular hydraulic
pressure of about 24mmHg. (32.5 cm H20)
 DENTIN PERMEABILITY (FLUID
CONVECTION)
• Under positive hydraulic pressure-Movement of
fluid in the dentinal tubules stimulates the A-fibers
producing sharp localised pain.
• Under negative hydraulic pressure- fluid
convection is away from the pulp when concentrated
solution such as sucrose, or saturated calcium
chloride are exposed to open dentinal tubules
producing sensitivity. Eg, cervical abrasion
• Presence of smear layer, cavity liners, sealers,
debri can reduce fluid convection.
 ADVERSE EFFECTS OF DENTAL
MATERIALS
• TOXICITY:- Cytotoxicity is the quality of being
toxic to cells
• Ist screening test
• INFLAMMATION:- second fundamental response
• ALLERGY:-Abnormal antigen-antibody reaction
to a substance that is harmless to most
individuals(hypersensitivity)
• MUTAGENICITY:-components alter the base pair
sequence of DNA in cells
• ALLERGY:- body specifically recognizes a
foreign material reacts disproportionately to
the amount of material present.
• TYPE I,TYPEII,TYPEIII- occur quickly mediated
by eosinophills,mast cells or basophils
• TYPEIV:- delayed hypersensitivity mediated
by monocytes and T cells.
• ALLERGY IS DOSE INDEPENDENT
• TOXICITY IS DOSE DEPENDANT
 Local and systemic effects
• Local effects occur in
1. Pulp tissue
2. Periodontium
3. Root apex
4. Nearby oral tissues
Depends on
• Distribution of material in these sites
• Their concentrations
• Exposure times
 Systemic effects

Routes of entry
1. Ingestion and adsorption
2. Leakge throgh tooth apex
3. Absorption throgh oral mucosa
4. Inhalation of vapour
Adverse effects of dental materials
• Degradation of dental materials-
By wear, corrosion and dissolution – materials
are released.
• Surface charecteristics of material
• Surface roughness
 IMMUNOTOXICITY
• Immunotoxicity is based on the principle that
small alterations in cells of immune system by
materials can have significant biological
consequences.
• It can either cause an increase or decrease in
cellular functions
• Eg mercury increases glutathione
• Palladium decreases glutathione
 INTERFACES WITH DENTAL MATERIAL

• Dentin-resin interface
• microleakage
• Implant – bone interface
• Implant success depends on osseiointegration
which in turn depends on biocompatibility
• Biointegration-bone and material with no
intervening space(bioglass ceramic)
 relevance
• Safety of the patient
• Safety of dental staff
• Regulatory compliance issues
• Legal liability
• Major requirements of biocompatibilty tests
1. The test should be performed under
conditions that simulate the actual use of
material in the body
2. The test conditions should reflect the effects
of materials time in the body.
3. The stresses induced in material under
intended functions should be considered in the
interpretation of biological response
 Assessment
• INVITRO TEST
• ANIMAL TEST
• USAGE TEST
 INVITRO TEST
• Outside body
• Interaction of any material on cell, enzyme or
any biological substance isolated from
organism.
• Metabolic / other cell function
• Effect on genetic material in Cell growth /
cytotoxicity
• Indirect – extract from the material in contact
with the cell
• Advantages
Quick, inexpensive, easy, standardized & well
suited for large scale screening
• Disadvantages
Questionable relevance to final in-vivo study on
same material & lack of inflammatory and other
tissue protective measures
 INVITRO TEST
• Primary test
1. Cytotoxicity
2. Hemolysis
3. Styles cell transformation
4. Ames test
5. Dominal lethal response
6. Oral LD50
7. Acute inhalational test
 ANIMAL TEST
• Secondary test
1. Mucous membrane irritation test(hamster
cheekpouch)
2. Dermal toxicity from repeated exposures to
subcutaneos implants(rats)
3. Sensitization(guinea pigs)
 USAGE TEST
• Material placed in human volunteer in its final
intended use
• MOST RELEVANT
• Difficult to control
 P
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Specific s
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Unspecific toxicity e
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 P
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secondary s
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 • P
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Primary
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 Usage

secondary primary
 Regulatory bodies
• ANSI/ADA specification no 41-recommended
standard practices forbiological evaluation of
dental materials
• FDA
• ISO 10993
 Current biocompatibility issues in
dentistry
• NICKEL :
• Common component of dental alloy
• 10%-20%-incidence of allergy
• Nickel subsulfide-respiratory carcinogen
• Ni2+- mutagen
• Nickel ions induce intercellular adhesions in
endothelium and release cytokines from
monocytes.
• Nickel carbonyl is extremely toxic used
industrially
• MERCURY AND AMALGAM:-
-relative long half life
-inhaled and ingested
-Stored in fat and nervous tissue
Mercury from dental amalgam alone is not toxic
• BERYLLIUM:-
• used in Ni-Cr alloys
• Increases castability
• Carcinogenic
• Inhaled berylllium casting particles- cause
berylliosis-chronic inflammatory condition
• During grinding and polishing
• LATEX:-
Gloves
Rubber dam
-localised rashes,wheezing,anaphyllaxis
-eczema
• RESINS:-
• Estrogenicity:-abilityof a chemical to act as the
hormone estrogen does to the body.
• Xenoestrogen:-if chemical is non indigenous
to the body
• Bis-phenol A
• Allergy with methyl meth acrylates
• Contact dermatitis
• IMPLANT MATERIAL
• There are four basic materials used in implant fabrication:
ceramics, carbon, metals, and polymers (and combinations of the
above).
• Have low toxicity, and are nonimmunogenic and
noncarcinogenic.
• DENTAL CERAMICS:-
• Highly biocompatible
• In low PH condition causes leaching of
silicone ions and metals
Eg- during application of APF gel
• ZIRCONIA:-
No local or systemic cytotoxic effect.

•Naturrally occuring RADIOACTIVITY has

been detected in certain ceramics,
Feldspathic and glass ceramic 10 times higher
radioactivitythan teeth
• HYDROFLURIC ACID:-
• Highly corrosive acid
• Used for etching of ceramics
• Readily destroys tissue
• Eye-blindness
• Skin; at high cocentration immedieate damage
• Low cocentration-slow damage
• Very painfull and slow healing
• Systemic effect- fluorosis
• Inhalation of HF vapors
• Can damage lungs
• Long term exosure flurosis
• 3ppm exposure for 8 hrs on workdays
• Used with adequate ventilation
• If exposed
• Eyes-irrigation with plenty of water 15 minutes
-calcium gluconte gel must be applied
• Skin:-
• Wash with water for 5 minutes
• Apply calcium gluconate gel
• Reapply every 15mts
• Calcium gluconate is not readily available wash for 15 mnts
• Calcium gluconate- antidote
• Prevents HF extraction of calcium from tissues and bone.
• Other chemicals like ammonium fluoride,sodium flouride
may react with water to produce HF
• Material safety data sheets(MSDS) of fluoride should be
used.
How to evaluate safety???????
 Clinical guidelines for selecting bio
compatible material
• Intended use and indication for restorative
materials
• Main component of material
• NO MATERIAL IS 100% SAFE
 references
1. Phillips science of dental materials- 1st south asia
edition
2. Craig RG, Restorative dental materials, 10th ed
3. John C. Wataha,Principles of biocompatibility
for dental practitioners;JPD;2000;83(2)
4. Kenneth.R, Biocompatibilty of dental materials;
Dental clinics of North America;2007;51(3)