Cements in pediatric dentistry. Requirements for materials for medical pads. Two main types of GIC

Two main types of GIC

2. Condensable GICs

Examples of clinical cases

Conclusion

The success of the restoration depends on many factors: the material used, the skills of the specialist and the characteristics of the patient himself. The latter characteristic determines the uniqueness of pediatric practice. Interaction with the patient reveals the preferred materials for manipulation with standard techniques. In addition, milk teeth differ from permanent teeth in their anatomy and temporary presence in the dental arch. And if the dentist has the same set of materials for permanent teeth as for temporary ( composite materials, amalgams, compomers and glass ionomer cements), restoration techniques temporary teeth are very specific. After evaluating the uniqueness of the temporary occlusion, a brief overview of the life span information of GRC, resin-modified GRC, and condensed GRC will be presented. Also, the fundamental principles of the use of these cements will be illustrated by clinical examples. Polyacid-modified composites (or compomers) will not be discussed in this article, as they are more similar to composites than GIC.

Material selection criteria in pediatric dentistry

This section is limited to choices based on the characteristics of deciduous teeth and types of caries. Primary teeth are characterized by the presence of a thin layer of enamel, consisting of enamel prisms, which are located vertically to the proximal surface. In cases of carious lesion, this thinness of the hard tissues can lead to extensive destruction exacerbated by poor cohesion of the prisms. The dentin also forms a thin layer with wide tubules allowing bacterial flora to easily enter and damage the pulp. That is why it is important to work with sealed materials. The pulp chamber of temporary teeth is evenly larger than that of permanent teeth, the pulp horns are more pronounced. Thus, carious lesions can occur very close to the pulp. Also in such cases, it is important to use highly adhesive materials that do not require the creation of additional sites for retention, which can cause pulp exposure. For the same reasons, smooth surfaces, areas covered with a thin layer of enamel, occlusal sulci and proximal surfaces of molars in young patients are subject to the most conservative treatment. The short crown, cervical constriction, close contact with adjacent teeth, and the large gingival papilla of primary teeth make it difficult to isolate the operative field, making the use of hydrophobic materials problematic (Burgess 2002). The use of hydrophilic materials becomes important. The application of fluorine releasing materials contributes to some reduction in the development and spread of caries on the proximal surfaces. In this regard, it is important to consider bioactive materials (Qvist 2010). Moreover, the materials used can affect the residence time. baby tooth in the dental arch. However, due to the relatively low masticatory pressure in children compared to adults (Braun 1996, Castelo 2010, Palinkas 2010), it is acceptable to use materials with lower mechanical strength in such situations. This explains the high role of glass-ionomer cements, inferior in strength to composites, in pediatric dentistry. Despite the lower mechanical parameters, such materials should be sufficiently hermetic, adhesive to hard tissues, bioactive and hydrophilic. Glass ionomer cements meet all these requirements.

The service life of restorative materials temporary teeth

An analysis of the literature shows that many parameters affect the service life of dental materials after their installation. Indeed, they take into account various factors: the type and brand of the material used, the experience of the specialist, the localization and depth of the carious lesion, as well as the age and characteristics of the patient. In addition, the lifespan of materials in temporary teeth is significantly different from that in permanent teeth (Hickel and Manhart 1999). This factor influences the choice of materials for filling temporary teeth. Yegopal 2009 conducted a study evaluating various materials in terms of pain relief, durability and aesthetics. The study concluded that from 1996-2009 there were only two properly conducted trials. These tests did not reveal a significant difference between the considered materials. In one such study, Donly 1999 compared modified GIC (Vitremer) with amalgams over a three-year period. However, due to the difficulty of following patients too long, results were obtained only over a 12-month period. In terms of service life, JIC is defined as a worthy alternative to amalgams and composites in the restoration of primary teeth for a limited period. Currently, two GICs are clinically valuable: modified and condensable. However, some studies differ in service life data depending on the type of GIC used in a particular cavity location (occlusal or proximal).

Two main types of GIC

For pediatric practice, the following types of JICs are particularly suitable:

1. Modified GRC with the addition of resins

Fuji II LC (GC), Riva Light Cure (SDI), Photac-Fil (3M-Espe), Ionolux (Voco).

2. Condensable GICs

Fuji IX (GC), Riva Self Cure (SDI), HiFi (Shofu), Ketac Molar (3M-ESPE), Chemfil Rock (Dentsply), or Ionofil Molar (Voco).

The main difference between the two materials is mechanical strength and application. Modified demonstrates moderate wear resistance, but requires sufficient time for the tooth to remain in the dental arch. Qvist 2010 reports that the service life of modified GRCs is about the same as amalgams, but longer than condensed ones. These materials can be used for occlusal and proximal restorations in temporary teeth that have been in the dental arch for about three to four years (Qvist 2004, Courson 2009). Modified GICs are generally preferred by those skilled in the art as photopolymerization can be used to cure them. Condensable GICs have the advantage of a one-step setup (especially valuable for proximal cavities) and the presence of chemical bonding). However, they are not as strong for proximal fillings (Qvist 2010). This material requires the presence of a tooth in the dental arch for two to three years, and small cavities are also recommended (Forss and Widstorm 2003). Larger cavities can sometimes be used, but in such cases a special crown is required (Courson 2009). A protective varnish (G-Coat Plus, GC) can be used, which prolongs the life of the restoration (Friedl 2011) and allows the restoration of permanent teeth in the posterior segment.

However, the bioactivity and the ability to release fluorine when coated with a protective varnish are questionable. It should also be noted that a new modified GRC: HV Riva Light Cure -SDI is already available and can be used as a replacement for condensable materials.

Examples of clinical cases

Regardless of the clinical situation, the surgical field should always be isolated if possible. For the two cases described, despite the inaccessibility, isolation was achieved. It is noteworthy that, regardless of the presence of isolation or its absence, the bioactive properties and the ability to release fluorine determine the significant advantage of GIC over other adhesive materials.

Case 1 (Dr. L Goupy)

An example of the restoration of proximal and cervical injuries of deciduous teeth using a modified JIC: Fujii II LC (GC)

Photo 1-a: X-ray of an 8-year-old child during a consultation. Discovered carious lesion under the ring of orthodontic construction (between 75 and 73).

Photo 1-b: Initial clinical view: from the occlusal plane. IRM applied during consultation

Photo 1-c: Initial clinical appearance: buccal

Photo 1-d: X-ray, hosted by IRM

Photo 1-e: Isolation of the tooth in order to obtain a surgical field. occlusal view.

Photo 1-f: Buccal view

Photo 1-g: Removal of necrotic tissue and placement of the matrix

Photo 1-h: Application of polyacrylic acid (10-20% for 15-20 seconds followed by rinsing and drying gently)

Photo 1-i: Cavity filling with Fuji II LC. occlusal view.

Photo 1-j: Buccal view

Photo 1-k: X-ray after the procedure

In this case, affecting the cervical region, filling with a modified GIC is a very appropriate procedure. On the proximal side, the use of a composite material is acceptable, since the field has been isolated. However, with practical benefit, the decision was made to use the same material in order to avoid two protocols for the restoration of one tooth.

Clinical case 2 (Dr. L Goupy)

An example of restoration of the occlusal surface of a temporary tooth using a condensable GIC: Riva Self Cure (SDI)

Photo 2-a: Initial view of tooth 64 (2 year old child)

Photo 2-b: Original X-ray

Photo 2-c: Isolation of the tooth in order to delimit the surgical field

Photo 2-d: Removal of necrotic tissue

Photo 2: Cavity filling with Riva Self Cure. It is recommended to apply polyacrylic acid (Riva Conditioner, 10-20% for 15-20 seconds, followed by rinsing and moderate drying).

Photo 2-f: X-ray after filling

Photo 2-g: Clinical view after one week. The restoration is stable, preserved its integrity, the anatomical shape is restored

Second clinical case fundamentally different from the first. He describes a carious lesion in a patient at a very early childhood. The use of GIC is due to the presence of high bioactive properties of the material.

Conclusion

The principal characteristics of GIC are: the ability to adhere to natural enamel and dentine, the cariestatic effect of fluorine, and tolerance to a humid environment. These materials are especially valuable in difficult clinical situations involving childhood and non-isolated cavities of temporary teeth. In such cases, it is desirable to use modified or condensable GICs, especially when cavities are located in places with increased mechanical stress.

Due to the following factors: in childhood, a very high percentage traumatic injury frontal group of teeth, because they erupt one of the first and protrude from the occlusal plane of the temporary teeth that have not yet changed. In addition, some dental pathologies can be observed mainly in children. So, for example, with destructive forms of hypoplasia or fluorosis, the teeth are destroyed so quickly that, due to the desire of doctors to follow the old method of treatment (namely, to wait for the closure of the tops of the roots), the only method of treating such teeth often becomes orthopedic restoration of the crown part.

For a long time, pediatric dentists were afraid to use composite materials in their practice, motivating this the following reasons:

• the impracticality of restoring a tooth that can still erupt;

• the impossibility of inserting teeth into the bite after various types of injuries, tk. micro-fractures appear in the root, which, if the load is not applied in time, can increase and lead to the death of the pulp and resorption of the tooth root.

• unsafe use of composite materials, tk. they are highly toxic and, in teeth with open apices and still wide dentinal tubules, can lead to pulp death.

· Inexpediency of using composite materials in the treatment of destructive forms of hypoplasia and fluorosis at an early age; their abrasion coefficient is lower than that of natural enamel. And in this regard, restorations made of composites after some time require repair or complete replacement.

In addition, often doctors and relatives of patients do not consider aesthetic restoration of teeth important at a young age and are limited to temporary structures, forgetting about psychological aspects. But the trend of today is such that it is fashionable to be healthy and beautiful.

The achievements of modern dentistry dispel the fears of using composites in pediatric practice. So, for example, with regard to toxicity, it is currently known that the bonding system has a direct effect on the tooth. Adhesive systems of the latest generation are not only non-toxic, but may also contain fluorine compounds in their composition. The toxic monomer contained in chemically cured composites has practically sunk into oblivion along with the use of chemical composites themselves.

Of course, before proceeding with the restoration, it is necessary to carry out all methods of examination (X-ray, EDI ...) At the same time, we must not forget that the protective forces of the child's body are very strong, and in each case we try to individualize the algorithm of actions.

Despite the fact that the evolution of composite materials is advancing by leaps and bounds, pediatric dentistry places increased demands on restorative materials:

• Low toxicity.
• High degree of adhesion of the material to the tissues of the tooth.
• Abrasion coefficient as close as possible to the natural tissues of the tooth.
• The possibility of immediate and final restoration of teeth (both frontal and chewing groups).
• Preparation that does not require intervention in healthy tooth tissues.
• Excellent aesthetic performance.

Tooth color is dictated by the optical characteristics of dentin and enamel. Enamel is responsible for the brightness of the tooth. Enamel is characterized by such a property as opalescence, this is the ability to reflect mainly short waves (blue) and transmit long ones (orange-red). The dentin is responsible for the color saturation of the tooth. Dentin of natural teeth has such a property as fluorescence. At present, the identity of the fluorescence of the material and the tooth is becoming an essential requirement for a modern composite. Another optical medium of the tooth is the dentin-enamel junction, which plays a large role in color formation.

According to various studies, most teeth belong to the shade - A on the Vita scale (Yamomoto 1992, Vanini 1994, Tuati 2000). Due to the fact that the enamel of children is brighter than that of adult patients, the color of their teeth most often corresponds to shades A1, A2 (according to Vita, since the most common lesions in childhood are injuries of the frontal group of teeth, accompanied by a violation of the integrity of the crown angle or the entire incisal edge, pediatric dentists need a material that reproduces all optical characteristics cutting edge of the tooth.

To date, the restorative material that best meets all the requirements of pediatric dentistry is Enamel Plus.

In the development of this material, L. Vanini took into account all the components of tooth color. His main task was to create a material, using which it would be possible to obtain a predictable result, which is so important in the daily practice of a dentist. The Enamel plus set includes three base enamels, seven universal fluorescent dentins, two intense enamels (to personalize the enamel on the surface) and opalescent enamels, which can be used to emphasize internal incisal opalescences and mamelons. (Fig. 2) In addition, the set includes glass connector. It is a flowable composite that mimics the protein layer of natural teeth and six stains to reproduce characterizations. To determine the color, it is proposed to use the Enamel plus scale, completely made of composite. (Fig. 3) The set also includes a special color card. This card remains in the history of the disease, and you can use it in future work. (Fig. 4, 4a)

For maximum results when using the system Enamel plus HFO it is proposed to use the anatomical layering technique developed by L. Vanini. Anatomical stratification technique involves the construction of lingual enamel, internal dentinal body and vestibular enamel.

Before proceeding to the consideration of the stratification technique, I would like to note some features of the preparation of cavities under Enamel Plus. The fact is that the preparation for this material is characterized by the possibility of maximum preservation of healthy tooth tissues and does not require the modeling of a fold on the enamel. It is by increasing the width of the fold and covering a larger surface of the enamel with a composite material that doctors often try to improve the aesthetics of their restoration (make the transitions of the material to the tooth tissues less noticeable and avoid the appearance of a gray stripe at the border of the filling with the tooth). At the same time, sometimes, restorations of extensive cavities of III and IV classes turn into the production of veneers by the direct method, which is absolutely incorrect in pediatric dentistry, especially in cases where the tooth has not yet fully erupted. When preparing under Enamel plus HFO on the vestibular enamel and proximal surfaces, along the edge of the prepared cavity, ball bur a gutter is formed, the palatal side is processed at 90 degrees. This preparation technique is very gentle. (Fig. 5, 5a)

Restoration of dental injuries without opening the pulp.

The most common defect requiring restoration in children is trauma to the frontal group of teeth without opening the pulp. The break line is parallel or diagonal to the incisal edge. In this case, the medial angle often suffers.

After filling in the color map, preparation and adhesive surface treatment, we begin to restore the lingual enamel. Because enamel in children has a high brightness, most often, we take the shade of enamel GE3. (Fig. 6, 6a)

To simplify the task with extensive defects, a silicone block is made, which allows the material to be distributed in a thin layer and to avoid inaccuracies in the formation of the macrorelief. "finger effect" (Fig. 8).

After application glass connector, we start modeling the dentinal body. To achieve optimal saturation of the restoration, 3 shades of basic dentin are used. For example, if we want to end up with A2 (according to Vita), we have to start with UD4, then layer on UD3 and UD2 - lighter ones.

At the stage of applying the last dentin, mamelons are modeled. (Fig. 10, 10a, 11, 11a, 12.12a)

The finished dentin body is covered with a thin layer Glass Connector.

To recreate enamel opalescence, opalescent enamel (OBN) is applied between the mamelons and in the incisal area. After that, if necessary, intensive white enamels (IM, IW), opalescent enamels (AO, OW) and characterization stains are applied. (Fig. 13, 13a, b)

Filling is the process of restoring a tooth, taking into account the anatomical features. In the modern world, technology allows you to take into account the color, structure and transparency of the surface.

For this procedure, specialized filling or restorative materials are used in dentistry. They are divided into several types and subspecies, which must meet certain requirements in accordance with their purpose.

Classification of filling materials

Materials for root canals are divided into several areas.

Depending on the group of the tooth:

1. For anterior teeth. Must meet cosmetic requirements.
2. For chewing teeth. They have increased strength and withstand heavy loads.

According to the material used in the manufacture of restoration fillings are:

• from metals: amalgams, pure metal, alloys;
• : composite, cement, plastic.

Depending on the purpose, filling materials are divided into:

• for overlays and dressings;
• for permanent fillings in diagnostics;
• laying if necessary treatment;
• insulating gasket;
• to close the root canal.

The materials used in the manufacture of seals are also divided according to their purpose.

The following cements are used for:

For insulating pads:

• zinc phosphate cements;
• glass ionomer cements;
• polycarboxylate cements;
• varnishes;
• dentine bond systems.

For medical pads:

• preparations based on calcium hydroxide;
• zinc-eugenol cement;
• materials containing medicinal additives.

What is Estelight filling material and its features of use:

What characteristics should dental materials meet?

Requirements for filling materials were developed and approved at the end of the last century by Dr. Miller. In modern dentistry, they almost did not change, minor additions and clarifications were made.

Restorative dental material must comply with the following technological and aesthetic standards:

Modern technologies have made it possible to come close to meeting these requirements, but still there is no ideal material at the moment.

For this reason, cases of combining restorative mixtures are quite frequent in dentistry. Up to 4 different layers can be used, depending on the characteristics of the tooth itself and tissues, location, characteristics of the disease.

In addition, the nature of work with types of materials differs in the tools used and the technical process.

The use and technique of working with various filling compositions depends on the area of ​​​​its application. Consider the most commonly used materials.

Phosphate and zinc phosphate cement

It has a wide range of applications: from permanent fillings with subsequent isolation to use as an insulating gasket when filling with other materials.

Sealing technique

Prepare powder and water. After that, they move on to the oral cavity. The tooth is isolated from saliva with cotton swabs and the cavity is dried with a stream of air.

Phosphate cement is mixed with a chrome or nickel-plated spatula. The consistency is considered ideal if the mass does not stretch, but breaks, leaving teeth no higher than 1 mm. The resulting composition is introduced into the tooth cavity in small portions, carefully filling the entire space.

It must be taken into account that filling and modeling must be completed before the material hardens. When removing the excess with a trowel, the movements should go from the center of the filling to its edges with great care.

When installing an insulating gasket, the mixture is applied over the entire surface of the cavity, including the walls, but does not reach the edge of the enamel, since this type of material is quickly absorbed and can cause corrosion of the cavity around the filling.

Zinc Phosphate Cement I-PAC

Due to the fact that its composition does not provide sufficient adhesion, and also has a pathogenic effect on the pulp, this operation carried out only with a phosphate cement gasket installed.

In the manufacture of an insulating layer, the mixture may be less thick than when filling, but not reach a creamy consistency.

After the phosphate cement has dried, they proceed to the application of the base material.

Sealing process

Silicate cement is also mixed with water until a homogeneous thick mass is formed and introduced into the cavity. It should be borne in mind that when working with this material, it is necessary to fill the space in 1, maximum 2 steps.

Since the partial filling of the cavity violates the solidity of the seal. It is necessary to model the shape and remove the excess before the material dries, since in the solid state it is difficult to eliminate deficiencies.

The final filling procedure is to cover the filling with wax, petroleum jelly or varnish.

Silicophosphate materials are also used. Due to the use of two materials, no additional insulating pad is required in this case. Mixing and filling proceed in the same way as for phosphate cement.

Polymer materials

Given that this group is aesthetically practical, it is used mainly on the front teeth. The process starts with

Filling material Vitremer

preparation of the oral cavity, isolation of the tooth and drying.

When using a polymer, a phosphate spacer is also required. Only after its application, they begin to manufacture a mixture of noracryl powder and monomer liquid.

A cellophane film is placed on the glass surface, the desired color of the plastic is selected. The powder is applied to the surface and thoroughly mixed with the liquid, the mass is rubbed over the cellophane with wide strokes of a spatula. The filling procedure is recommended to be carried out in two stages.

Immediately after kneading, when the consistency of the composite is rather liquid, the first part of the mass is added, thereby displacing the air from the cavity and filling the irregularities. After that, make the second part until full filling.

Form modeling takes place on initial stage hardening the material with a trowel. Do not rush to eliminate the excess in the elastic state of the composite, so you can break the edge adhesion.

This material completely hardens within a day. At the next visit, the patient is given the final revision of the filling. In this case, the surfaces of the grinding material must be moistened with water and used at low speeds to avoid heating the seal.

Uses of Acrylic Oxide

This material has increased resistance to physical and chemical irritants, high adhesion to surfaces and does not lose color for a long time.

An insulating gasket is applied only in cases. After selecting the desired shade, acrylic oxide powder is poured into the crucible.

The cement is kneaded general requirements, if necessary gaskets. Next, liquid is added to the crucible and stirred for about 50 seconds. A mass of solution is applied to the prepared cavity in one go.

The hardening of the material begins after 1.5 - 2 minutes, during this time it is necessary to model the filling. Full curing time takes 8 to 10 minutes. After that, the final stage of machining takes place.

Composite material consize

AT recent times The recently developed new composite filling material Consize has become popular. It has high aesthetics, good adhesion to fabrics and other materials.

But given that with such a filling, the tooth enamel is treated with acid, it is imperative to apply an insulating gasket. The advantage of using this material is the absence of pre-preparation.

Installation Method

The surface is thoroughly cleaned by mechanical treatment. Etching liquid is applied for 1.5-2 minutes, after which the tooth washed clean water and dry thoroughly.

After this process, it is necessary to ensure that the tooth is isolated from saliva. The etched area will acquire a pretty shade. Then two equal parts of the liquid filling material are mixed with a swab and applied to the area.

After that, two parts of the previously prepared paste are mixed and the cavity is filled. When modeling, a trowel is used, and in case of significant defects, a cellophane cap is used.

Surpluses should be eliminated before consizing solidifies. The hardening of the seal takes up to 8 minutes, after which you can proceed to mechanical processing. All materials, including paper napkin and foam swabs, are included.

The article discusses modern filling materials most commonly used in dentistry. Before starting work, it is necessary to carefully determine the degree of the patient's disease and the defect of the teeth.

Filling material Estelight

Since manufacturers use components with different consistency in the manufacture of materials, it is necessary to read the instructions before starting filling. The time of solidification, thickening of the mixture may vary slightly. But at the slightest deviation from the required conditions, the seal may lose the required properties.

Children's teeth require a special approach when carrying out hygiene procedures. The enamel on the teeth is thin and can be easily damaged. That is why the choice of toothbrushes and cleaning pastes is a paramount task for caring parents.

Most manufacturers of dental products include lines for children in their range. Our store offers:

• toothbrushes for caring for teeth and cleansing the oral cavity;
• quality pastes, which do not include components hazardous to health.

We carefully control the quality of each item included in the catalog of goods on the site. All products offered to you have been repeatedly tested and received certificates of quality and compliance with international norms and standards.

Baby pastes, which you can buy online on our Internet site, are distinguished by a safe composition and delicate texture. And the interesting "cartoon" design of the packaging will surely appeal to children and will be another reason to brush their teeth.

How to buy dental products for children in Moscow?

Bright brushes, beautiful tubes of pastes and mousse bottles are a great choice for the first acquaintance of babies with oral hygiene products. Start it with pleasant emotions and, be sure, brushing your teeth will become a favorite pastime for the baby and will not cause denial.

Placing an order in the All4dental online store is easy: select the products you like in the catalog, go to the page with the item and click "Buy". After filling out the opened form, wait for a call from our manager and confirm your order. We ship products throughout Russia and deliver to Moscow and the Moscow region. Prices for children dental materials will pleasantly surprise every visitor of our site.

Take a closer look at brush sets - such sets are convenient and practical, and buying them helps save money. You can buy the same hygiene products for several children, or save an extra brush to replace the one you use now.

Children's pastes are attractive and pleasantly smelling, gently care for the teeth and help strengthen them.

When choosing products, please Special attention to the purpose of the item. Many toothpastes and brushes are categorized according to the age of the child. The manufacturer indicates all such data on the packaging of the product, and we - on the page where it is placed.

Dental cements are widely used in pediatric therapeutic dentistry, especially for filling temporary teeth, as well as pads for protecting the pulp.
According to the modern classification (D. S. Smitn, 1995), there are 4 types of dental cements:

1. Phosphate: zinc phosphate, silicophosphate, silicate.
2. Phenolic: zinc-eugenol, Ca (OH) 2-salicylate.
3. Polycarbox and plate: zinc-polycarboxylate, glass ionomer.
4. Acrylate: polymethylacrylate, dimethylacre and plate.

Recently, it has been proposed to add tin fluoride (SnF2) in amounts of 1-3% to the composition of zinc-phosphate cements, which certainly increases their cariesstatic effect.
Phosphate cement powder consists of 75-90% zinc oxide, the rest is oxides of magnesium, silicon, calcium and aluminum. The liquid is an aqueous solution of phosphoric acid, partially neutralized with hydrates of aluminum oxide and zinc.
The cement mass for gaskets or seals is prepared by mixing the liquid with the powder for 1-1.5 minutes. The criterion for readiness is such a consistency of the resulting mass, when it does not reach for the spatula, but comes off, forming teeth no higher than 1 mm. Do not add liquid to a densely mixed mass.
Silicate cements ("Silicon", "Silicin-2", "Fritex") differ from phosphate cements in their composition. Silicate cement powder is crushed glass, consisting of aluminosilicates, fluorine components and dyes. The liquid is similar to that in phosphate cements, but differs in the proportional composition of the components. Silicate cements have better physical and mechanical properties compared to phosphate cements: they are resistant to the conditions of the oral cavity, have a color and luster close to enamel. However, they are rather fragile, do not withstand the chewing load, and can adversely affect the dental pulp. Silicate cements are mainly used for filling carious cavities of classes I, III, V, they are not recommended for contact fillings and for filling carious cavities of class IV.
In pediatric dentistry, silicate cements with an appropriate liner can be used in permanent teeth with established roots. In temporary teeth, silicate cements are recommended for filling depulped teeth.
Silicate cements are kneaded for 1 min. The mass is considered to be cooked correctly if, when lightly pressed with a spatula, its surface becomes wet (shiny) and does not reach for the spatula. When working with silicate cements, it is not advisable to use a metal spatula and metal matrices.
Silicophosphate cement ("Silidont") - is a mixture of powders of phosphate (20%) and silicate (80%) cements.

Silidont has good adhesion, plasticity, toxic properties are less pronounced, it is quite hard and resistant in the cavity, however, it differs in color from the tissues of the teeth, which limits its use.
Silidont is quite widely used in pediatric therapeutic dentistry for filling carious cavities of classes I, II and V in temporary molars, classes I, II and V in permanent molars and premolars. An insulating gasket is required when working with a silydont.
The method of preparing a cement mass from silydont is similar to silicin.
Silikofosfatny cements are intended only for temporary teeth ("Laktodont", "Infantid"). They have low toxicity due to high content zinc oxide powder and a smaller amount of phosphoric acid in liquid. This allows them to be used without insulating pads, which is especially convenient when filling shallow carious cavities in temporary teeth in young children. However, these cements have less mechanical stability, therefore, in the case of filling contact carious cavities, their use is limited. In permanent teeth, they can be used for insulating linings.
Phenolate-based cements contain zinc oxide and purified eugenol or clove oil (85% eugenol). A chemical reaction occurs between zinc oxide and eugenol in the presence of water to form zinc eugenolate. The hardening reaction occurs very slowly, therefore, substances that can accelerate it (for example, zinc salts) are added to the composition of cements. Industrial cements harden within 2-10 minutes, acquiring sufficient strength after 10 minutes, which makes it possible to put a permanent filling from any permanent material on a gasket made of such cement.
The advantage of zinc-eugenol cements is, undoubtedly, their favorable influence on the pulp. They have odontotropic and anti-inflammatory properties. However, high solubility in the oral fluid and low mechanical strength make it possible to use such cements only for linings and temporary fillings. Zinc oxide eugenol cements should not be used for direct pulp capping, as eugenol is a strong irritant. It is also a potential allergen. In addition, be aware of incompatible

sti composite materials with gaskets that contain eugenol.
Chelated cements with calcium hydroxide Dycal (Dent Splay), Life*, etc. Appeared in the early 60s. These are cements of the phenolate type, based on the reaction of hardening of calcium hydroxide with other oxides and esters of salicylic acid. These cements consist of two pastes, one containing calcium hydroxide and the other chemical compounds which provide fast curing.
The cements containing calcium hydroxide are widely used in the treatment of acute deep caries and for direct capping of the exposed pulp horn, their advantages are ease of use, fast hardening, favorable effect on the pulp. Disadvantages: insufficient hardness, possibility plastic deformation, solubility in the presence of marginal permeability with leaky filling.
Polycarboxylate cements (Poly-F-Plus; Carbocement; Adgesor-Carbofine). The powder contains zinc oxide with the addition of magnesium and calcium salts, the liquid is a 3050% aqueous solution of polyacrylic acid. Significant advantages of these cements are almost complete safety for hard tissues and dental pulp and the ability to chemically bond with enamel and dentin. They are ideal for filling temporary teeth, as they do not require an insulating lining and have a pronounced adhesion to the hard tissues of the tooth.
In permanent teeth, polycarboxylate cements are used as lining materials and for temporary fillings. The duration of mixing the powder with the liquid should not exceed 20-30 s, in order to maximize the use of adhesive properties, it should be used for 2 minutes. If the surface of the cement mass becomes dull and thin threads appear in it, then this portion of cement is unacceptable for further use.
Glass ionomer cements are modern filling materials that combine the properties of silicate and polyacrylic systems.
Glass ionomer cements consist of a powder (finely ground calcium and aluminum fluorosilicate) and a liquid (50% aqueous solution of polyacryl-polyitaconic or polyacrylpolymaleic acid copolymer). In some materials, a copolymer is added to the powder and water is used as the mixing liquid.
According to the generally accepted classification (K W. Phillips, 1991), there are several types of glass ionomer cements:

1. type - cements for fixing crowns, prostheses, orthodontic appliances (Aqua Cem, Fuji I, Ketac-Cem);
2. type - restorative (for restorations) (Fuji II, Ketacfil, Chemfil).

1. th subtype - for aesthetic restorations;
2. th subtype - for loaded restorations (Fuji IX).

1. type - lining cements (Baseline, Aqua Ionobond).

Macrofilled composite materials (macrophiles) are materials with a filler particle size of 1100 microns (usually 20-50 microns). These include the first generation of materials Evicrol (Spofa Dental), Consize (3M), Adaptic (Dent Splay), Visio-Fill, Visio Molar, etc.
These materials have high mechanical strength, chemical resistance, good marginal fit, but they are almost not polished and quickly change color. As it turned out, this happens because the organic base is destroyed during operation, it partially dissolves, which leads to the precipitation of filler particles from the organic matrix. This leads to a further increase in the roughness of the fillings. Dyes, food residues, bacteria quickly settle on such a surface, the filling becomes stained, becomes aesthetically unsuitable. The filling loses its shape, interdental contacts are broken.
In this regard, macro-filled composite materials were used mainly for filling carious cavities of class I and II, class V in the lateral areas, i.e. where it is necessary to have a mechanically strong filling and aesthetics is not important.
Microfilled composite materials (microfils) - materials with a filler particle size of 0.040.4 microns. These are materials such as Isopast (Vivadent), Degufill-SC, Degufill M (Degussa), Durafili (Kulzer), Helio Progress (Vivadent), Helio-Molar (Vivadent), Silux Plus (3M).
Fillings made of these materials have high aesthetic properties, perfectly imitate tooth tissues, are well polished and retain their color for a long time. However, microfilaments have insufficient mechanical strength, which is associated with a low filler content (up to 50% by weight and only 25% by volume). Therefore, they are mainly used for filling carious cavities of III, V classes and enamel defects of non-carious origin and in places where chewing load is minimal.
Hybrid composite materials are materials whose particle size ranges from 0.04 to 100 microns. They appeared in the late 70s and combine the qualities of macro- and microphiles. Hybrid composites contain filler particles various sizes and quality. Changing the ratio of large and small particles makes it possible to purposefully change the properties of composites. The most common today are such hybrid composite materials: Valux Plus (ZM),

Prisma (Dent Splay), Hercuiite XPV (Kerr), Charisma (Kulzer), Tetric (Vivadent), Arabesc (VOCO). Most hybrids contain 80-85% filler.
These composites are not without reason considered universal, therefore they can be used for filling carious cavities of all classes, as well as for the complete restoration of the crown part of the tooth and the reconstruction of the dentition. Fillings from these materials have many advantages, such as: maximum
high mechanical strength, chemical resistance, high aesthetics and color fastness, minimal shrinkage and high adhesion.
Depending on the mechanism of polymerization, all composite and polymeric materials are divided into: polymer and chemically curable (or self-hardening); polymerized under the influence of heat (used for the manufacture of inlays in the laboratory); polymerized under the influence of light.
Self-hardening composites are available in the form of two pastes or powder and liquid. They include an initiating system of benzoyl peroxide and aromatic amines. The advantage of chemically curing composites is uniform polymerization regardless of cavity depth and filling thickness. However, there are a number of disadvantages. This is the inhomogeneity of the filling mass after mixing the components, limited working time, uneconomical work.
Composite materials that polymerize under the action of light are increasingly being used. They are polymerized by the light energy of a halogen lamp, which produces high-intensity blue light with a wavelength of 450-550 nm, which penetrates to a depth of 2-3 mm.
The radiation intensity of all halogen lamps must be checked with special radiometers. It is known that a luminous flux of 450-500 mW/cm2 (milliwatts per square centimeter) ensures effective polymerization of the material at a depth of up to 3 mm in 20 s, and with a luminous flux of 300 mW/cm2, complete polymerization does not occur.
It is known that the disadvantage of all composites is polymerization shrinkage, which is approximately 2 to 5 volume percent. The reason for shrinkage is the decrease in the distance between the monomer molecules during the formation of the polymer chain. The intermolecular distance before polymerization is 3-4 A (angstrom), and after polymerization - approx.

positively 1.54 A. That is why the next stage in the improvement of composite materials was the creation of adhesive systems for enamel and dentin.
When working with photopolymer materials, in order to reduce the polymerization shrinkage of the material, one should adhere to following recommendations: introduce small portions of the material into the carious cavity so that the thickness of its layer is 1.5-2.0 mm., use an adequate source of polymerization light with a wavelength of 450-500 mm; direct the light source from the side opposite to the filling material, carry out starting illumination through the enamel; adhere to the polymerization time of each layer according to the recommendations in the instructions.
Table 2.
Physical properties of filling materials compared to dental hard tissues

material; while working with a halogen lamp, you should follow the safety rules: work with safety glasses and a protective screen; after completion of the filling, the final (final) illumination of the material should be carried out. In particular, in the cavities of classes I and V, respectively, from the chewing and vestibular surfaces, in the cavities of classes II, III, IV - from the vestibular, oral, chewing surfaces.
The method of using photopolymer composite materials involves a number of steps:

1. Anesthesia.
2. Professional hygiene all surfaces of the teeth.
3. The choice of shades of the filling material, which is carried out using the "Vita" color chart. In this case, the surface of the tooth and the scales should be slightly moistened, the selection of color should be carried out in daylight natural light.
4. Preparation of a carious cavity.

1. The etching of enamel and dentin is an extremely important stage, since mistakes made in the process of etching the hard tissues of the tooth can lead to the development of complications. According to recent studies, the etching time is 30 seconds, of which 15 seconds are etched into the dentin. Etching gel is first applied to the enamel, and after 15 seconds - to the dentin.
2. Rinse off the pickling gel plain water within 45-60 s.

1. Drying of the carious cavity is carried out very carefully so as not to damage the surface of the etched dentin. The air jet is directed at an angle to the surface of the enamel, in order to avoid overdrying of the dentin.
2. Primer application. The first portion of the primer is brought into the carious cavity with a special brush with a small excess and left for 30 seconds. During this time, the primer penetrates deep into the dentin and impregnates the collagen structures. After that, a second layer of primer is applied, it is slightly dried with a stream of air and polymerized under the action of light for 20 seconds.
3. Application of adhesive. The adhesive is also applied with a brush to the surface of the enamel and primed dentin and with particular care in the area of ​​the enamel fold. The adhesive is also slightly dried with a stream of air and polymerized for 30 seconds.
4. Introduction of the composite. The filling material is introduced into the carious cavity using Teflon or titanium-coated trowels and pluggers. The thickness of each composite layer should not exceed 1.5-2 mm. The layer-by-layer technique of applying the composite allows achieving maximum polymerization and shrinkage reduction. During irradiation, the composite should, if possible, be polymerized through the enamel or through previously applied layers to maximize the "welding" of the composite to the enamel and previous layers. The second irradiation is carried out perpendicular to the surface of the composite. It should be remembered that the shrinkage of the material is directed towards the light source.
5. Rebonding. This is the application of an enamel adhesive to a formed and polymerized filling in order to eliminate micropores between the filling and enamel, as well as possible microcracks on the surface of the composite.
6. Sanding and polishing composite filling carried out in order to give it a final shape and shine. For this, finely dispersed diamond burs, carborundum finishing burs are used, and strips and flosses are used for approximal surfaces.

that. In this case, total etching causes its aggravation. Therefore, in doubtful cases it is advisable to conduct an EOD.
Others, quite frequent complication after the restoration of the tooth, the composite material is postoperative sensitivity of the dentin, microleakage of fluid from the dentinal tubules and depressurization of the seals.
Under the sensitivity of the dentin understand acute, prolonged, localized pain that occurs in response to tactile, thermal or osmotic stimuli. This pain is not spontaneous and stops after the removal of the stimulus. Sometimes the chewing load can also be the cause of pain.
Causes of dentin hypersensitivity may be violations of the total etching technique, insufficient acid leaching from the carious cavity after etching, overdrying of the dentin, deep penetration of the adhesive into the dentinal tubules and its insufficient polymerization. To prevent micro-leakage and depressurization of fillings, primers should be used that reliably “seal” the dentinal tubules, as well as a directed polymerization technique to reduce the polymerization shrinkage of the composite.
Compomer is a new class of filling composite materials that combine the qualities of composites and glass ionomer cements. They are distinguished primarily by high adhesion to the hard tissues of the tooth, especially to the dentin, due to the use of adhesive systems, as well as a positive effect on hard tissues tooth by prolonged release of fluoride. They do not require preliminary etching of the hard tissues of the tooth, which reduces the risk of complications and simplifies the method of working with them. The most famous representatives of this class of materials are Dyrect (Dent Splay), DyreetAP (Dent Splay), F-2000(3M), Elan (Kerr), Hytac (ESPE), Compaglass (Vivadent). They are used for filling cavities of all classes in temporary teeth and cavities III, V classes in permanent ones.
Compomers, like glass ionomer cements, can be used as a backing material or as a permanent filling material in the treatment of carious cavities in immature permanent teeth in children and adolescents, as they do not require dentine etching.