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

with 5-15 seconds between layers Do not leave the lid off .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.

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) 2 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 .

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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.Luting-Cementation  Luting  Cementing 2 components together such as an indirect restoration cemented on or in a tooth. such as inlays. bridges. orthodontic brackets and bands. crowns.

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

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

like Sedative or provisional restoration • Evaluate pulp  Also used for teeth waiting to be restored . may be used for class V  Intermediate restorations (IRM)    Mix to secondary consistency Putty .Restorations  Permanent or temporary  Not frequently chosen for permanent     Lower strength Wear resistance Higher solubility Except for glass ionomer • Releases fluoride.

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 .

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

 Mechanical and chemical can occur together .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).e.

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 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.

cement side down on the palm of your hand to dentist .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.

Loading the Restoration .

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 .Removal of Excess Cement  Follow  manufacturer’s instructions for appropriate consistency for removal Rubbery.

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

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 .

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

Zinc Oxide Eugenol (Secondary Consistency) .

thermal protection Incremental incorporation while mixing Mix over large area on glass slab Zinc oxide powder Liquid  Phosphoric acid + water . indirect restoration High strength base.Zinc Phosphate          Oldest cement Not widely used today Powder-liquid system Luting.

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 .

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      Cool glass slab Shake powder.

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 .

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

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 .

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

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 .

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

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

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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