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Keywords Abstract
Cleaning method; crown retention; temporary
cement.
Purpose: To evaluate the effect of temporary cement cleaning methods on the re-
tention of cemented crowns using zinc phosphate cement and resin-modified glass
Correspondence
ionomer cement.
Eun-Jin Park, Professor, Department of Materials and Methods: Forty titanium specimens were fabricated to simulate pre-
Dentistry, School of Medicine, Ewha pared molars with minimally retentive taper. The Ni-Cr cast crowns were fabricated,
Womans University, 1071, Anyangcheon-ro, temporarily cemented, and separated. The specimens were divided into four groups
Yangcheon-gu, Seoul 07985, Korea. according to the temporary cement cleaning method (n = 10) as follows: control
E-mail: prosth@ewha.ac.kr group (no temporary cementation), orange solvent group, ultrasonic cleaning group,
and air-abrasion group. After the cleaning procedures, the specimens were cemented
The authors deny any conflicts of interest. with definitive cements (zinc phosphate cement and resin-modified glass ionomer,
RMGI, cement) and subjected to thermocycling (5000 cycles, 5-55C, dwell time,
Accepted March 10, 2017
10 seconds). The tensile bond strength of each specimen was measured using a uni-
versal testing machine, and the results were analyzed using the Kruskal-Wallis and
doi: 10.1111/jopr.12646
Mann-Whitney U test ( = 0.05).
Results: When cemented with zinc phosphate cement, the statistical analysis showed
that the value of the air-abrasion group was significantly higher than those of the
other groups (p < 0.01). There was no statistically significant difference among the
other groups. When cemented with RMGI cement, the air-abrasion group showed
the lowest value, and the control group showed the highest value (p < 0.01). The
difference between the ultrasonic cleaning group and the orange solvent group was
not statistically significant.
Conclusion: The use of temporary cement did not have a significant influence on
retention of permanently cemented crowns when zinc phosphate cement was used for
permanent cementation. Airborne-particle abrasion after provisional cementation im-
proved retention of crowns cemented with zinc phosphate cement; however, the use of
temporary cement significantly decreased retention of permanently cemented crowns
when RMGI cement was used regardless of the temporary cement cleaning method.
Cementing a restoration on an interim basis is occasionally remnants of the cement have been observed microscopically
advised so that the patient and the dentist can assess its appear- on surfaces that appeared macroscopically clean.7,8 Therefore,
ance and function over a period longer than a single visit.1,2 methods such as airborne-particle abrasion, ultrasonic clean-
Zinc oxide-eugenol (ZOE) cements are commonly used for ing, or the use of organic solvents may be needed for improved
temporary cementation because of their sedative effect, ease cleaning.9-12
of removal, low cost, and excellent sealing property.3 After Traditionally, zinc phosphate cement (ZPC) has been a very
provisional cementation with ZOE cement, the cast restora- popular material despite its well-documented disadvantages,
tion has to be carefully cleaned and luted with more definitive including its solubility and lack of adhesion.1,13 The retention
cement.4 The remnant debris of the ZOE cement on the in- of cast restorations cemented with ZPC is mainly influenced by
taglio surface of cast restorations may have a negative effect the configuration of the tooth preparation that limits the paths of
on the performance of definitive cement.5,6 The mechanical displacement of the cast restoration.14 The luting ability of ZPC
removal of temporary cement using an excavator or a scalpel is derived from mechanical retention.15 However, conventional
blade has been found to be not completely effective, and the glass ionomer, resin-modified glass ionomer (RMGI), and resin
was removed with cotton pellets saturated with the orange sol- Table 2 Comparative significance of statistical analysis for ZPC
vent (Smart Cleaner; Florida Chemical, Winter Haven, FL)
Group C OS U AA
until the intaglio surface of the crowns looked clean macro-
scopically. Then, an alcohol-saturated cotton pellet was used to C
remove the Smart cleaner residue. For the third group (U), OS ns
the ultrasonic cleaning method was used. The cast crowns U ns ns
were dipped into the temporary cement remover solution AA
(P&S cleaner II; Mediforce, Tampa, FL) and cleaned with
an ultrasonic cleaning device for 10 minutes. For the last *p < 0.05. **p < 0.01. ***p < 0.001. ns; p 0.05.
group (AA), the airborne-particle abrasion and steam-cleaning
Table 3 Comparative significance of statistical analysis for RMGI
method was used. Airborne-particle abrasion was applied to
cement
remove the temporary cement using 110 m aluminum ox-
ide powder at 0.48 MPa, and the cast crowns and dies were Group C OS U AA
steam-cleaned.
C
OS
U ns
Permanent cementation and tensile bond
AA
strength test
The specimens were cemented with ZPC (Flecks zinc phos- *p < 0.05. **p < 0.01. ***p < 0.001. ns; p 0.05.
phate cement; Mizzy, Cherry Hill, NJ) and RMGI cement (GC
FujiCEM; GC Corp.). After the test for the ZPC, all the spec- The crown-die specimens were mounted on a universal test-
imens were cleaned using ultrasonic cleaning for 10 minutes, ing machine, and the tensile bond strength values of the spec-
followed by airborne-particle abrasion, and steam cleaning. The imens were measured on a universal testing machine at a
same specimens in each group in the ZPC test were used again 0.5 mm/min crosshead speed. The ultimate force required for
for the RMGI cement. the separation was recorded from the digital screen of the test-
The ZPC was mixed following the manufacturers instruc- ing machine in kg. The tensile force values required for the
tions, and then applied to the crown using a syringe (E/Z Sy- separation of the specimens were calculated in Newtons (N)
ringe; Centrix, Inc., Shelton, CT). A Centrix tip with marking according to the following equation:
was used to provide equal amounts of cement. One investiga-
tor cemented all the specimens. The crowns were seated on Tensile bond strength (N) = Force (kg) 9.8067 (m/s2 )
their counter dies after they were vibrated and twisted back and A statistical analysis was performed using the Kruskal-Wallis
forth, as Rosenstiel and Gegauff recommended.27 The 1-mm and Mann-Whitney U test ( = 0.05) to evaluate the effect of the
vent hole improved the complete seating of the crown, and cleaning methods depending on definitive cements (SPSS 12.0;
5 kg constant load was applied to the crowns for 10 minutes.28,29 IBM, Armonk, NY). Nonparametric tests were used because
The RMGI cement was mixed according to the manufacturers the data did not meet the assumption of normality.
instructions, and then applied to the crown. The cartridge (GC
Corp.) was used to make equal amounts of cement, which pro- Results
duced uniform quantities of mixed cement for each squeeze.
After the permanent cementation, the specimens were sub- The mean tensile strengths of the two definitive cements for
jected to thermocycling (5000 cycles, 5-55C, dwell time, each cleaning method are shown in Table 1. The results of
10 seconds);30-33 10,000 thermocycles has been suggested to statistical analysis are given in Tables 2 and 3.
correspond approximately to 1 year of in vivo functioning.34 A few of the specimens in this low-retention design were
The regimen of 5000 thermocycles in this study could be con- spontaneously separated after the thermocycling. The thermo-
sidered as 6 months usage. cycling had a detrimental effect on the retention properties of
the cements,23 and the minimally retentive design of the prepa- this study shows that the orange solvent method, if done with
ration in this study resulted in a low tensile bond strength. caution, can be as effective as the ultrasonic cleaning method.
The tensile strength of the separated specimens could not be The tensile strengths of OS and U groups for ZPC were not
measured and were excluded. significantly lower than that of the control group. This means
For ZPC groups, the value of group AA was significantly that the cleaning methods using the orange solvent and ultra-
higher than those of the other groups (p < 0.01). There was no sonic cleaning can be used to remove temporary cement simply
statistically significant difference among other groups. and conveniently in clinics when ZPC is used as definitive ce-
For RMGI cement, group C showed the highest retention ment; however, to obtain maximum retention, particularly with
(p < 0.001), and group AA showed least retention (p < 0.001). compromised preparations, airborne-particle abrasion is rec-
Group AA did not have a high value for RMGI cement, un- ommended for cleaning temporary cement prior to permanent
like the result of group AA for ZPC. The efficacy of the ul- cementation with ZPC.
trasonic and orange solvent cleansing methods did not show RMGI cement has been recommended due to its hybrid
significant difference for both ZPC and the RMGI cement properties similar to glass-ionomer cement, with the addition
(p > 0.05). of a small quantity of resin such as hydroxyethyl methacry-
late or bis-GMA.51 The adhesive and fluoride-leaching prop-
erties of these materials have led to their widespread use as
Discussion restorative, lining, and luting materials.52 Because the speci-
mens did not have natural tooth structure, but were made of
The retention of fixed prostheses depends on many factors, metal, the RMGI cement was luted without bonding forming a
including the preparation taper,35 the preparation height,36 hybrid layer. Therefore, the conditions of this study differed
the method of cleaning the preparations,37 the type of core from those of the oral environment, and mechanical bond-
material,38 the thickness of die-spacer,39,40 the surface area of ing rather than chemical bonding of the RMGI cement was
preparations,41 the surface roughness of the preparations,42 the measured.
surface roughness of the internal surface of the cast crown,12 The possible negative effect of eugenol-containing tempo-
the auxiliary grooves,43 and the type of cement used.16 Be- rary cement on RMGI cement is the inhibition of the poly-
cause the design of the preparation in this study was inten- merization of the resin material or the smoothing of the mi-
tionally compromised, the effect of the remnant temporary ce- croroughness of the intaglio surface of the cast crown and the
ment on the crown definitely appeared. Among several ways milled dies, which play the role of barriers. There is controversy
to remove temporary cements, airborne-particle abrasion with in the literature regarding the interaction between resin-based
alumina is a less sensitive technique in terms of producing a cement and eugenol-containing cement residues. Millstein and
rough alloy surface, is inexpensive, and can improve adhesive Nathanson53 reported that the retention of crowns cemented
and cement wetting because of the mechanical removal of the with resin cement was greatly reduced when pretreated with
debris.44 eugenol-containing temporary cement. They also reported that
Kim et al45 reported that surface modification with airborne- the reduced retention could be attributed to inhibition of poly-
particle abrasion is an effective way to improve retention when merization of resin cement. Terata et al54 reported that the
Temp-Bond is used, and Gurbuz et al46 noted that airborne- remnant of temporary materials could reduce the wettability
particle abrasion had a positive effect on the retention of over- and infiltration of the adhesive on the tooth structure, and that
tapered complete metal crowns. ZPC is commonly used in the main reason for decreased bond strength was the prevention
clinical practice, and the surface roughness might be a main of the infiltration of the adhesive into the tooth rather than the
factor for the tensile strength in cases of low retention. In inhibition of the polymerization of the resin.55 Abo-Hamar et
this study, the airborne-particle abrasion group had a higher al56 and Peutzfeldt and Asmussen57 also reported that previ-
value than the control group, which was cemented with ZPC ous contact of dentin with ZOE cement did not decrease the
without provisional cementation. The airborne-particle abra- bond strength of composite resin on dentin. On the other hand,
sion on the intaglio surface of the crowns gave a higher reten- Hume58 noted that eugenol was not only present in and released
tion value than that of the control group, for which only a pre- from the remnants of cement, but had also been shown to pene-
treatment procedure was performed; however, airborne-particle trate the dentin to change its wettability and reactivity. Being a
abrasion should be applied with extreme caution because sig- radical scavenger, eugenol inhibits the polymerization of resin
nificant marginal damage can occur during the procedure,47 and materials,59 and this inhibited polymerization might lead to re-
marginal disintegrity or surface roughness can mediate exces- duced microhardness and color stability of the composite resin
sive plaque accumulation, which will eventually jeopardize gin- that was polymerized in contact with ZOE cement.3,60-62
gival health.48 The chemical organic solvents including alcohol, The control group had a significantly higher value for
soap, chloroform, and eucalyptus oil or an ultrasonic removal the RMGI cement than for the other groups, on which
solution dissolves and removes the temporary cement.1,2,49,50 provisional cementation and subsequent cleaning procedures
In this study, the efficacy of the ultrasonic and orange solvent (p < 0.001) were performed. Especially, the airborne-particle
cleaning method did not significantly differ for both ZPC and abrasion method for the RMGI cement showed the lowest ten-
the RMGI cement. Although the remnant of temporary cement sile strength, and its result was opposite to the result of ZPC.
was cleaned very carefully with the orange solvent, the effi- Although the airborne-particle abrasion method could extend
cacy of this method might be variable because the standard of the surface area and provide micromechanical retention, the
macroscopically clean can be subjective; however, the result of remnant of the eugenol-containing temporary cement was not
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