Dental Cements

Chapter 13

Uses of Dental Cement

Pulpal

Protection Luting-Cementation Restorations Not one cement will work for all of your needs

Pulpal Protection
Pulpal

irritation created by

Bacterial effects from caries Biologic response to chemicals in restorative materials Cutting tooth structure Thermal conductivity

Pulpal Protection
Cavity

Varnish

Acts as a protective barrier between preparation and restoration Placed on the walls and floor of the prep Seal tubules Minimize leakage Solution of
Natural resins (copal) Synthetic resins dissolved in a solvent such as alcohol/chloroform

Apply 2-3 layers, with 5-15 seconds between layers Do not leave the lid off

Pulpal Protection
Varnishes

not used much today Dentin bonding agents have replaced

Product seals enamel tubules and dentin

Liner/Low Strength Base

Calcium

hydroxide Commonly used

Dycal paste

Used

when dentin no longer covers

pulp Small pulp exposure is expected Stimulates secondary dentin and insulator

Due to alkali (pH is 9-11)

Paste: Base and catalyst, use = amounts

High - Strength Base/Liner

Used

when deep cavity leaves 2mm or less of dentin over the pulp Provides thermal insulation Support for restorations Cement used like base

Thick, putty-like consistency (secondary consistency) Roll into a ball Thickness 0.5mm

BuildUp
Provides

mechanical support Used when excessive amount of tooth structure is removed Provides and reinforces foundation before crown

Luting-Cementation
Luting

Cementing 2 components together such as an indirect restoration cemented on or in a tooth, such as inlays, crowns, bridges, veneers, orthodontic brackets and bands, and posts and pins

Permanent

and temporary luting

Fixed prosthesis Orthodontic bands

Luting-Cementation
Fills

the restoration-tooth interface 10-2 Primary consistency

Tacky

Luting-Cementation
Must

flow to have a film thickness of .25m or less Oral fluids can cause dissolution of the cement

Bacterial plaque can accumulate beneath a crown and result in recurrent caries Chemical bonded cements are better at reducing this problem

Restorations

Permanent or temporary Not frequently chosen for permanent

Lower strength Wear resistance Higher solubility Except for glass ionomer
Releases fluoride, may be used for class V

Intermediate restorations (IRM)

Mix to secondary consistency Putty - like Sedative or provisional restoration

Evaluate pulp

Also used for teeth waiting to be restored

Surgical Dressing
Surgical

site

Provide protection Support

Patient

comfort Help control bleeding Mixed to a putty-like consistency which will harden over the tissue

Surgical Dressing

Properties of Dental Cements

Strength Solubility Viscosity/Film

Thickness Biocompatability Retention Esthetics Ease of manipulation

Strength
Good

comprehensive strength Strongest

Resin cements
Weakest

Zinc oxide eugenol (ZOE)

Different

cements have different strength qualities Increase powder, increase strength

Add too much, you will weaken

Solubility
Big

hurdle

Most tend to dissolve in fluids within oral cavity Causes mircroleakeage recurrent caries

Resin

cements (lower solubility (stronger, less likely to wash out) than amalgam)

Most insoluble

Viscosity
Consistency

of mixed cement is the measure of its ability flow under pressure

Needs to flow Mixed thin, consistency of honey
Primary consistency

Low

film thickness

Critical for seating and retaining indirect restorations (25m or less)

i.e. crown and bridge

Low

temperature

Slow setting time Gives more working time to clinician

Viscosity
Secondary

consistency requires additional powder

Thick, putty-like Roll in a ball Utilized as a base and restoration (perm or temp) More powder will increase strength and decrease the solubilty

Biocompatibility
Many

cements represent combination of zinc oxide powder or powdered glass and an acid Eugenol has sedative effect Powered glass cements

Release fluoride-reduces secondary caries

Consider

pH of cement (due to acid)

This can cause irritability of the pulp

Retention
Accomplished

by adhesion

Attach one substance to another by bonding dissimilar materials by the attractive forces of atoms or molecules Mechanical adhesion
Based on the interlocking of one material with another

i.e. Velcro

Chemical adhesion
Occurs at the molecular level when atoms of the two materials swap atoms (ionic bonding) or share outer electrons (covalent bonding).

Mechanical and chemical can occur together

Retention
Adhesion

may be weakened

Differences in the coefficient of thermal expansion of the two materials Dimensional changes during setting of the adhesive agent Contamination of the substrates by water/saliva or by residual enamel and dentin debris (smear layer)

Causes

microleakage, margins compromised = secondary caries

Retention
Semifluid

cement penetrates microscopic irregularities on all surfaces and restoration

Resistance to microleakage Highly retentive

Glass

ionomers

Form weak chemical bonds

Aid in retention Reduce microleakage

Esthetics
Cements

available in variety of shades and opacities Would like a more translucent effect for light to pass through the restoration Mask the color of dentin

Manipulation
Mixing

Follow manufacturers directions Hand mixed Pad or glass slab (room temp or cold?) Pre-dosed capsules Automixing cartridges

Setting

Chemical Light cured Combination

Note
Keep

powder and liquid separate Fluff powder Level scoop of powder, not heaping Dispense uniform drops of liquid Close caps immediately after dispensing Incorporate

Incremental mixing?

Both

sides of spatula Mix in 8-figure motion Test viscosity

Loading the Restoration

Gather

cement from mixing surface with the blade of the spatula Wipe the blade against the margin of the crown Cover all the walls with a thin even coating of cement Pass the crown, cement side down on the palm of your hand to dentist

Loading the Restoration

Removal of Excess Cement

Follow

manufacturers instructions for appropriate consistency for removal

Rubbery, rock hard, tacky

Remove

cement in bulk when possible Use an explorer or scaler to remove from smooth surfaces Use a piece of knotted floss to remove cement from interproximal areas (or scaler) Complete removal is essential to maintain gingival health

Zinc Oxide Eugenol (ZOE)

Powder/liquid

or paste-paste system

Base, catalyst

Temporary

cement, and intermediate restoration, base, root-canal sealer, surgical dressings Zinc oxide (may have resin enforces too) Eugenol

Distinct smell of cloves, oil of cloves

Zinc Oxide Eugenol

Advantages

Disadvantages

Wide variety of uses Sedative to pulp Easily manipulated Highly biocompatible

Cannot use under composites Low strength High solubility Cannot use under indirect restorations cemented with resin or glass ionomer

Zinc Oxide Eugenol (ZOE)

Mixing to primary consistency if using a paste Equal lengths about 1 inch Pad or glass slab Mix using both sides of the blade of the flexible spatula Lifts 1 inch up in air (ice cream)

Mixing to 2ndary consistency Glass slab Shake liquid, fluff powder Dispense liquid at one end and powder at other Incorporate in 2 increments or all at once, mix, roll in a ball

Zinc Oxide Eugenol (Secondary Consistency)

Zinc Phosphate

Oldest cement Not widely used today Powder-liquid system Luting, indirect restoration High strength base, thermal protection Incremental incorporation while mixing Mix over large area on glass slab Zinc oxide powder Liquid

Phosphoric acid + water

Zinc Phosphate

Advantages

Disadvantages

Long clinical hx Low film thickness Inexpensive High rigidity

Initial pulp irritation

Low acidity

Mechanical bond only Technique-sensitive Relatively high solubility

Zinc Phosphate

Cool glass slab Shake powder, dispense on one end, liquid on other Increments of powder (see manu) Each mixed from 1015 secs Mix in a figure 8 motion over LARGE area (absorb heat from
exothermic reaction)

Zinc Phosphate

Mix should string up 1 inch for primary luting consistency HARD to remove from spatula and glass slab, CLEAN BEFORE CEMENT SETS

Zinc Polycarboxylate
First

to develop adhesive bond to tooth structure Final cementation of indirect restorations Powder-liquid Powder

Zinc oxide Polyacrylic acid

Liquid

Zinc Polycarboxylate

Advantages

Disadvantages

Bonds to tooth structure Nonirritating to the pulp Inexpensive Easy to use

Higher solubility Lower strength Shorter working time

Zinc Polycarboxylate

Powder/liquid Slab or pad Use manu scoop and dropper Powder to liquid Mix 30-60 secs Short working time

Lose gloss and become stringy = cannot use anymore

COBWEBS-no use

Glass Ionomers
1969 Continue to evolve Versatile Release fluoride
Intro

Aluminum fluorosilicate glass

Perm

luting, restorative, high strenth base, build ups

Traditional Glass Ionomers

Powder-liquid

system Encapsulated to mix in amalgamator Powder

Calcium fluoralumionsicate glass with barium glass Polyacrylic acid copolymer in water

Liquid

Powder

and liquid mix

Polyacid attacks the glass to release fluoride ions

Traditional Glass Ionomers

Biocompatible

with pulp Over-drying of the prep and moisture contamination during first 24 hrs

Possible sources of sensitivity

Fluoride

release for life or restoration

Anticariogenic effect

Must

isolate when using as a build up Use varnish on margins to protect from moisture (indirect restorations)

Traditional Glass Ionomer Cement

Advantages

Disadvantages

Chemical adhesion to the tooth Fluoride release Easy to mix Moderate strength

Hx of post operative sensitivity Moisture sensitive during setting

Hybrid Glass Ionomers

Glass

ionomer + resin Resin:

improves bond strength and compressive and tensile strength Reduces solubility
Rely X

Hybrid Glass Ionomers

Advantages

Disadvantage

Good strength Fluoride release Insoluble Chemical adhesion to the tooth Less post op sens Excellent film thickness

Not recommended for all ceramic restorations

Due to expansion of the material as it absorbs moisture after setting

 Apply

3M Scotchbond etchant to enamel and dentin; wait 15 seconds (Figure 1); rinse 10 seconds. Blot excess water with a 3M mini-sponge or moist cotton pellet, leaving tooth moist.

Apply two consecutive coats of 3M Single Bond adhesive to enamel and dentin (Figure 2). Dry gently for five seconds. Avoid excess adhesive on all prepared surfaces.

Light-cure each surface for 10 seconds

Roughen the bonding surfaces of indirect composite crowns with a diamond or air abrasion. Apply 3M RelyX ceramic primer (#2721) to etched porcelain and roughened metal surfaces. Dry for five seconds

Dispense cement onto a mixing pad and mix for 10 seconds. Apply a thin layer of cement to the bonding surface of the restoration

Slowly seat the restoration. Remove excess cement approximately three to five minutes after seating. Optional: If excess cement is removed immediately after seating, light-cure margins for 40 seconds after clean-up.

Once the crown is seated, margins may be lightcured for 40 seconds (Figure 7) or allowed to self-cure for 10 minutes from start of mix. Note: For porcelain and pre-cured composite crowns, margins must be light-cured for 40 seconds.

Resin-Based Cements
Composite

resin Adhesive resin Compomer

Modified

composite material Bonding indirect ceramic restorations

Light-cured Dual-cured Chemically cured

Resin-Based Cements
Small

filler particle size Pigments are added for matching the tooth color Virtually insoluble Difficult to remove excess cement is difficult once completely set Low viscosity for crowns and bridges

Resin-Based Cements

Advantages

Disadvantages

High strength Insoluble Low wear Excellent bond Esthetic shades available Light cure, chemical cure or dual cure

Requires additional steps

in the etch and bonding procedure in preparation of internal restoration surfaces

Removal of excess cement may be difficult