Two key-words “dental amalgam” and “toxicity” were used to search publications on dental amalgam biocompatibility published in peer-reviewed journals written in English. For dental materials, local effects might occur in the pulp tissue, in the periodontium, at the root apex, or in nearby oral tissues such as the buccal mucosa or tongue (Figure 7-2). Microorganisms and various natural processes can convert metallic mercury to inorganic mercury compounds, inorganic mercury compounds to organic mercury compounds, and organic to inorganic compounds. Mercury leaves the body by excretion through urine and feces. For example, a visual sign of erythema in soft tissue adjacent to a new restoration may have resulted from mechanical trauma or an allergic reaction. Material components can be released during melting and casting of metals, fabrication of prostheses, grinding and polishing procedures, adhesive bonding, or cementing to prepared teeth. The concern about estrogens in dentistry centers around a chemical called bisphenol A (BPA), which is a synthetic starting point for bis-GMA (bisphenol-A-glycidyldimethacrylate) composites in dentistry as well as many other plastics. As a result, these individuals develop symptoms such as asthma, rhinoconjunctivitis, or eczema. The color of the material depends upon the light source, how the light interacts with the material, and the visual response of the observer. Several types of beverages have caused degradation of two types of dental ceramics. Many individuals have sensitivities to certain chemicals and other environmental factors that need to be taken into account before using a specific dental … This outward fluid pressure from the pulp chamber toward the enamel is not sufficient to eliminate the inward diffusion of bacteria, bacterial products, or material components into the pulp. Log In or. The difference between dissolution and corrosion is primarily related to the difference between chemical concentration gradients and electrical current gradients. Biocompatibility testing in the future may lead to more reliable predictions of adverse effects, and this knowledge of biological properties may allow us to formulate materials that provide specific, desired biological responses. This specification represented great progress toward the establishment of biological tests for dental materials. Some materials such as bioglass ceramics promote a perfect osseointegration of the bone. In vitro biocompatibility tests are performed in a test tube, cell-culture dish, or otherwise outside of a living organism. A dental implant that is osseointegrated today may or may not be osseointegrated in the future. These values place the 1 to 3 µg/day of absorbed Hg0 vapor from amalgams in perspective. Classical progression of biocompatibility tests for evaluating a group of new dental materials. The occurrence of xenoestrogens in the environment has been a concern for many years. The purpose of this review paper is to review the literature regarding the toxicology of mercury from dental amalgam and evaluate current statements on dental amalgam. Figure 7-13 shows a plot of cellular glutathione from monocytes that were exposed to mercury or palladium ions in a cell culture. Thjere are three different levels of biocompatibility to consider: general, immunological, and bio-energetic. However, in 2005, the ADA decided to phase out the Seal of Acceptance program for professional products. The primary purpose of biocompatibility tests is to protect dental patients who will be treated with the materials and the office staff and lab technicians who will be handling these materials. The simplest definition of biocompatibility is the ability of a substance to exist within living things without harming them. Since glutathione is essential for maintaining the redox balance in the cells, exposure to these metallic ions can change the cellular function of the monocytes. The Clean Air Act Amendments were enacted by Congress in 1990 and legislation has made several minor changes since 1990. If these chemicals are not indigenous to the body, the substance is called a xenoestrogen. Since the 1980s, testing has focused on primary tests for cytotoxicity, hemolysis, Styles’ cell transformation, the Ames test, the dominant lethal response, oral LD50, intraperitoneal (IP) LD50, and the acute inhalation test. There are many types of tests for biocompatibility. Acute symptoms are neurologically based or kidney based, ranging from paresthesia (at 500 µg/kg or above) to ataxia (at 1000 µg/kg or above), joint pain (at 2000 µg/kg or above), and death (at 4000 µg/kg or above). It has the same technological characteristics (includes chemistry, materials, design specifications, mechanical, or biological properties, etc. In 1930, the American Dental Association (ADA) formed a Council on Dental Therapeutics to oversee the evaluation of dental products. Methyl mercury is the most common form that is transformed by natural processes; it is a more toxic form than ethyl mercury (C2H5Hg+) or elemental mercury. When substances are excreted slowly, their critical concentrations are reached more rapidly than are those concentrations of substances that are excreted quickly. However, there is considerable uncertainty about which types of exposures lead to the, Tests for the safety of restorative dental materials must ensure that a candidate material is nontoxic and unlikely to cause adverse immunological effects. One current regulatory issue with its origins in biocompatibility is hypersensitivity to latex. These effects are controlled by the substances that are released from the material and the biological responses to those substances. Biocompatibility tests Swetha, et al. As reactions to latex products become more common and better documented, such regulatory pressures are certain to persist. The Biocompatibility test for Dental Materials is to determine how great of an immune reaction a patient will have to a dental material. Concerns about mercury stem from its toxicity and its relatively long half-life in the body. Intermediate-duration exposure—The contact with a substance that occurs for more than 14 days and less than 1 year (compare with acute toxicity and chronic exposure) (U.S. Agency for Toxic Substances and Disease Registry). The inflammatory response involves the activation of the host’s immune system to ward off some challenge or threat. Numerous tests for the body burden of mercury have been developed, including those based on the analysis of blood, urine, and hair. Yet there are profound consequences of this definition for orthodontic practitioners. Fig. Further, the periodontal pocket, or gingival sulcus, may accumulate significant concentrations of leached substances that do not accumulate to these levels in other areas. Osseointegration—The process of forming a direct structural and functional interface between live bone and an artificial implant surface without any intervening fibrous connective tissue. The primary risk for the dental team in orthodontics appears to be contact with latex-based and resin-based materials. No effects of mercury have been noted. An allergic reaction occurs when the body recognizes a substance, molecule, or ion as foreign, and the human immune system can react quickly, as during an anaphylactic reaction or slowly in delayed contact dermatitis. As in (a), each level of the test screens for the tests above it. Some studies indicate that leaching of bisphenol A decreases over a relatively short period, and the results suggest that the toxicity risk is extremely low. In air, the concentrations of mercury range from about 0.01 to 0.02 µg/m3. sockets have much greater weight and cause wear of the titanium alloy. 2 International Dental & Medical Journal of Advanced Research Vol. The +LPS line represents the effect of cell stimulation by lipopolysaccharide while the –LPS line indicates that the monocytes were not stimulated by lipopolysaccharide. ANSI/ADA Standard No. One widely accepted definition of biocompatibility is “the ability of a material to elicit an appropriate biological response in a given application.” If examined closely, this definition implies an interaction between a host, a material, and an expected function of the material (Fig.14.1). The nature, severity, and location of these effects are determined by the distribution of released substances. Because natural estrogens have many powerful and widespread effects on growth and development, xenoestrogens are a concern for all animal life in our environment. The mechanisms by which these materials cause problems are not known, but there is evidence that some resin components such as HEMA (hydroxyethyl methacrylate), TEGDMA (triethylene glycol dimethacrylate) and camphoroquinone (Chapter 9) are capable of activating immune cells directly. Other studies have measured renal function in patients in whom all of the amalgam was removed at the same time (the worst possible case). When a new product is introduced on the dental market, the advertisements tend to promote the clinical performance but rarely summarize the biocompatibility tests and results of these tests compared with results from control materials. It is therefore in the best interest of the practitioner to understand dental biocompatibility issues. 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