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 .

use = amounts .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) 2 Paste: Base and catalyst.

High . putty-like consistency (secondary consistency) Roll into a ball Thickness 0.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.5mm .

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

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and posts and pins  Permanent   and temporary luting Fixed prosthesis Orthodontic bands . veneers. such as inlays.Luting-Cementation  Luting  Cementing 2 components together such as an indirect restoration cemented on or in a tooth. orthodontic brackets and bands. bridges. crowns.

Luting-Cementation  Fills the restoration-tooth interface 10-2  Primary consistency  Tacky .

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25m 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 .Luting-Cementation  Must flow to have a film thickness of .

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

you will weaken .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.

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 .

crown and bridge  Low   temperature Slow setting time Gives more working time to clinician . consistency of honey • Primary consistency  Low  film thickness Critical for seating and retaining indirect restorations (25m or less) • i.Viscosity  Consistency   of mixed cement is the measure of its ability flow under pressure Needs to flow Mixed thin.e.

putty-like Roll in a ball Utilized as a base and restoration (perm or temp) More powder will increase strength and decrease the solubilty  .Viscosity  Secondary    consistency requires additional powder Thick.

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 .

 Mechanical and chemical can occur together .e.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. Velcro  Chemical adhesion • Occurs at the molecular level when atoms of the two materials swap atoms (ionic bonding) or share outer electrons (covalent bonding).

margins compromised = secondary caries .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.

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 manufacturer’s directions Hand mixed Pad or glass slab (room temp or cold?) Pre-dosed capsules Automixing cartridges  Setting    Chemical Light cured Combination .

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 .Note  Keep powder and liquid separate  Fluff powder  Level scoop of powder.

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  manufacturer’s 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 .

surgical dressings  Zinc oxide (may have resin enforces too)  Eugenol  Distinct smell of cloves. base. catalyst  Temporary cement. root-canal sealer. oil of cloves . and intermediate restoration.Zinc Oxide Eugenol (ZOE)  Powder/liquid  or paste-paste system Base.

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 .

mix.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. roll in a ball . fluff powder Dispense liquid at one end and powder at other Incorporate in 2 increments or all at once.

Zinc Oxide Eugenol (Secondary Consistency) .

indirect restoration High strength base.Zinc Phosphate          Oldest cement Not widely used today Powder-liquid system Luting. 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. 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) . dispense on one end.

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

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 .

build ups . restorative. high strenth base.Glass Ionomers – 1969  Continue to evolve  Versatile  Release fluoride  Intro  Aluminum fluorosilicate glass  Perm luting.

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. Blot excess water with a 3M mini-sponge or moist cotton pellet. wait 15 seconds (Figure 1). . rinse 10 seconds. leaving tooth moist.

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

Light-cure each surface for 10 seconds .

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

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

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

. 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 .

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