1.

Luting cements
a. Permanent & provisional indirect restorations b. Orthodontic brackets c. Post and cores

2. Restorative materials
a. Permanent and provisional direct restorations
1) Class V restorations

3. Amalgam bonding agents (certain resin cements) 4. Cavity liners & Bases
a. Pulp protection

5. Multiple applications
a. No one cement can fulfill all requirements

Cement
CaOH Zinc oxide eugenol ZO non-eugenol Zinc polycarboxylate Zinc phosphate Glass ionomer (GI) Resin-modified GI Resin cement Adhesive resin cement

Setting mechanism
Acid-base Acid-base Acid-base Acid-base Acid-base

Applications 1 2
Pulp cap agent Liner Temporary luting Temporary luting Luting agent Luting agent Cl V restorations Base Liner Base Liner Base Amal bond

Acid-base AND Luting agent polymerization Class V Polymerization Luting agent Polymerization Luting agent

1. *Low film thickness (25 m) 2. *Adequate strength (minimum 70 MPa) 3. *Low solubility (0.2% max. @ 24h) 4. *Reasonable setting time (2.5-8.0 min) 5. Adequate working time 6. Biocompatible, not irritate pulp 7. Cariostatic 8. Adhesion to tooth structure and restorative materials *ADA and ISO specification requirement

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1. Zinc-oxide eugenol cement 2. Zinc polycarboxylate cement 3. Zinc phosphate cement 4. Glass ionomer cement 5. Resin-modified glass ionomer 6. Resin cement 7. Adhesive resin cement

1. Powder: Zn Oxide; Liquid: Eugenol

a. Sedative, obtundent

2. Temporary cement and restorations

3. ZOE unmodified, TempBond
4. ZOE polymer-reinforced (IRM)
a.Temporary cement: Retention or time b.Provisional/intermediate restoration

5. Not use prior to resin-based permanent

cement, Why?

1. Powder: Zn oxide; Liquid: Polycarboxylic acid/H20

1. Temporary cement 2. Eugenol replaced with other oils 3. Used prior to permanent resin-based cement 4. TempBond NE
a. Slow set b. Low retention

2. Low strength:
a. Compressive, 55-67 MPa (ADA spec minimum = 70 MPa) b. Highly viscoelastic, restoration dislodgement

3.Used as temporary cement

a. Better retention ZO eugenol or non-eugenol provisional cement b. Chelation interaction: cement COO- & Ca+ tooth surface (Physical interaction + and -) c. Bond strength: ~1-2 MPa

4. Durelon, Ultra-Temp
a. Can be used prior to resin cement
Why?

D6138 L-5

1. Powder: Zn Oxide; Liquid: Phosphoric Acid/H2O

2. Low bond strength: micromechanical with tooth and crown irregularities

a. No chelation interaction b. Bond strength: 0.5-1.5 MPa c. Preparation retention and resistance form critical

1. Powder: Calcium fluoroaluminosilicate glass Liquid: Polycarboxylic acid/H2O 2. Fluoride release 3. Bond strength: 3-5 MPa
a.Chelation, cement COO- and Ca+ tooth surface

4. Post-cementation hypersensitivity
a.Early protection (varnish) to prevent hydration and dehydration of initially set cement

3. Luting agent or base

5. Brands: Ketac-Cem, GlassLute

Acid-base cements
Zinc phosphate cement (ZP) Zinc oxide-eugenol cement (ZOE) Zinc polycarboxylate cement (ZPC)

1. RMGI

EUG

2. Hybrid ionomer
3. Resin ionomer 4. Introduced due to limitations of conventional GI cements
a. Low initial mechanical properties b. Moisture sensitivity

Phos ZnO (powder) Poly acid acid FAS glass

(powder)
Central Concepts in Dental Materials, EC Combe

Glass-ionomer cement (GI)

D6138 L-5

1. Powder
a. Fluoroaluminosilicate glass (same as GI)

2. Liquid
a. Polycarboxylic acid/H2O (same as GI) b. Resin monomers, vary with products
1) HEMA 2) Bis-GMA 3) Replace some of the water of conventional GI

1. Acid-base reaction

(Conventional GI setting reaction) Fluoroaluminosilicate glass + Polycarboxylic acids F, Al hydrogel

2. Monomer (methacrylate) polymerization

a. b. c. Chemically-activated Light-activated Dual-activated

c. Photoactivator (Light-activated only)

1. Fluoride release (source?) 2. Low solubility: 0.07-0.40% 3. Bond strength

Bond strength (MPa) Material Dentin Alloy (Rexillium III) All-ceramic
(alumina or zirconia)

4. Expansion
a. Water sorption, hydrophilic resin (HEMA) b. Decreased expansion with new formulations
*Dentin bond agent (DBA) can increase RMGI dentin adhesion. However, DBA use contraindicated: 1) fluoride release 2) add another interface, RMGI/DBA

RMGI *5-10 7-12 10-15 5-10 10-15

GI 3-5 5-7 3-5 3-5 5-7

1) Less HEMA 2) More BisGMA, hydrophobic resin

c. RMGI contraindicated: all-ceramic restorations

1) Restoration fracture due to luting agent expansion 2) Glass and glass-infiltrated ceramics more prone to fracture (discuss in later lecture)

Amalgam core Composite core

(Powers & Sakaguchi 06; 3M ESPE)

D6138 L-5

1. Powder/liquid system (2 bottle)

a. Fluff powder b. Equal number powder scoops &

2. Capsulated powder/liquid system

a. b. c. d. Triturate 10 sec No dispensing: less error, faster Less voids than hand-mixed Brands: Fuji Plus (GC)

liquid drops (bottle held vertically)

c. Rely X: crown (3 scoops); bridge (6 scoops) UMKC d. Powder, liquid mixed within 30s e. No light activation/chemical only

f. Brands: Rely X (3M ESPE);

Fuji Plus (GC); CX Plus (Shofu) RelyX vs Vitrebond (liner/base) vs Vitremer (restorative/core) How are they different?

3. Paste/Paste systems
a. 2-tube dispenser b. Mix on pad c. Quicker dispensing d. Less dispensing error e. Brands: 1) Fuji Cem 2) RelyX Plus Geristore (DenMat)

1. Dispense and mix immediately

a. Prevent water evaporation from liquid

2. Mixing time: 20-30 sec maximum 3. Working time: 2.5 min 4. Apply thin layer inside restoration 5. Seat restoration
a. Tooth should be clean and dry, NOT dessicated
1) Post-op sensitivity

6. Excess cement removed after 3 minutes

Not a luting agent Liner, base, Class V, root caries, subgingival restorations, retrograde root filling a. Difficult to remove later

7. Final set time: 5 minutes

a. If necessary, adjust occlusion and polish

D6138 L-5

1. Metal-supported crowns and fixed partial dentures 2. Prefabricated or cast endo posts 3. All-ceramic restorations? 4. Not high bond strength, not appropriate when retention compromised

1. Poly-acid modified composite 2. Fluoroaluminosilicate glass 3. Methacrylate monomer

a. Modified with polyacid groups

4. Polymerization rxn only 5. No initial polycarboxylic acid-base rxn

a. Possible later acid-base rxn with water from tooth?

6. NOT resin-modified GI 7. Brand: Principle (Dentsply),

1. Unfilled or filled (inorganic/glass filler particles)

1. Introduced in 1950s: unfilled resin

a. Resin only problems
1) High polymerization shrinkage 2) High coefficient of thermal expansion (higher than tooth or crown) 3) Lead to microleakage and restoration failure

a. Resin cement vs Resin composite cement

2. Polymerization reactions
a. Light-activated (Light-cure) b. Chemical-activated (Chemical-, Self-cure) c. Dual-activated (Dual-cure)

3. Use of dentin bond agent (DBA)

a. Some resin cements do not require DBA
1) RC bonds directly to tooth (Adhesive RC)

2. Current resin cements late 1980s

b. With some, DBA applied to tooth prior to RC

1) DBA bonds to tooth, resin cement bonds to DBA (Non-adhesive RC)

D6138 L-5

1. Physical bonding: very weak interaction, 2 bonds 2. Chemical bonding: strongest bond, 1 bonds a. Limited occurrence, usually dissimilar materials b. Example: composite bond to adhesive bond agent 3. Mechanical bonding: a. Micromechanical retention
Powers and Sakaguchi 06

1. ZnPO4, GI, RMGI

a. Cement locks into microscopic irregularities of prepared tooth and crown internal surface b. Additional chelation between Ca+ and COO-: GI, RMGI
1) Physical interaction +/- ions

c. Lower bond strengths

2. Resin cements
a. Enamel: resin tags in etched enamel (minimal crown prep) b. Dentin: hybrid layer c. Dentin/Cement interface varies ---RC brand 1) Cement not requiring DBA: a)Resin cement directly bonded to tooth
Adhesive RC interface: Tooth/RC/Crown

1. Most of the current resin cements are filled (resin composite cement)
a. Filler: solubility, polymerization shrinkage, thermal expansion

2. Current unfilled resin cement:

a. C & B Metabond (Parkell)

2)Cement requiring DBA:

a) DBA bonded to tooth and RC bonded to DBA Non-adhesive resin cement interface: Tooth/DBA/RC/Crown (another level added)

3)15-30 MPa bond strength

D6138 L-5

4-META/MMA-TBB Resin Cement

1. Unfilled cement 2. Chemical-activation 3. Composition:

C & B Metabond

4. Manipulation
a. Etch, rinse, dry tooth b. Base/Catalyst/Powder mixed 10-22C
1) Highly exothermic reaction 2) Package warning: spontaneous combustion

a. Base: 4-META/MMA (4-methyloxy ethyl trimellitic anhydride/ Methylmethacrylate) b. Catalyst: TBB (tributyl boron oxide) c. Powder: Polymethylmethacrylate powder NO glass filler particles - not a composite d. Same composition as AmalgamBond

5. Application: metal-based restorations

4-META/MMA-TBB Resin Cement

6. Advantages
a. Direct bond to tooth, No DBA b. Medium-high strength bond (~17 MPa) c. Use with over-tapered preparations, short axial walls

1. Basic Description
a. Bis-GMA based resin b. Filler: Silanated glass, silica particles c. Polymerization activation
1) Light, Chemical, Dual

7. Disadvantages
a. Bond strength NOT long-term:~10 MPa at 1 yr
(Kitasako et al 02)

b.Higher solubility (related to bond strength):

1) MMA more soluble than Bis-GMA-based RC 2) No filler, also adds to increased solubility c. Difficult removal of excess, Technique-sensitive product

d. Brand dependent use of DBA

8. Short-term fix
a. Initial good bond. Over time, solubility counteracts

D6138 L-5

1. No dentin bonding agent, RC directly linked to tooth (Adhesive resin cement) 2. Chemical-activation 3. Composition
a. Bis-type methacrylate/TEGDMA b. 10 MDP: Phosphate ester, Adhesive monomer for tooth
structure, metal, ceramics

4. Manipulation
a. Self-etching primer: ED primer (Liquid A & B)
1) Apply for 60 sec, then dry. Do not rinse. 2) Acidic HEMA primer: pH ~2-3 3) Do not use conventional phosphoric acid etch

b. Mix catalyst & base pastes, 20 sec

1) Spread thin on pad 2) Prevent premature set

c. Filled ~80 wt%: Silanated filler particles (Barium glass, Silica)

c. Apply to restoration, seat

Panavia 21 available at UMKC

4. Manipulation
d. Clean excess cement
1) Use microbrushes, gauze 2) Floss to remove interproximal excess

1. Same system as Panavia 21, except

a. Dual-activated
1) Additional photo-activator, light on margins prior to Oxyguard

e.Apply Oxyguard to margins & wait ~3-4 minutes

1) Panavia, anaerobic set 2) Oxyguard: prevent oxygen inhibition, chemical activators included 3) Be sure no excess cement remains before Oxyguard placement 4) After Oxyguard placement, the cement will set. Once set, almost impossible to remove excess. Can bond teeth together.

b. Sodium fluoride (fluoride release)

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1. Advantages
a. Low solubility, sorption, expansion b. High bond strengths c. Hybrid layer, demineralized dentin + filled resin cement: Micromechanical union
C: Panavia D: Dentin Hybrid layer (arrows)

2. Disadvantages
a. b. c. d. Expensive Multiple steps Careful with clean-up, difficult to remove after polymerized Post-operative sensitivity
1) More common prior to self-etching primer (ED primer)

3. Bond Strength (MPa):

a. Dentin: ~20-25 b. Enamel: ~30-35 c. Ceramics: ~35-40 d. Alloy (Noble and Base): ~35-40
1) High noble alloys: High gold (40%) alloys

Increases Panavia bond strength to high noble (gold) alloy

(1) Must use Alloy Primer on alloy (2) NOT Tin plate

Added to Panavia kit at UMKC Kit instructions (NOT CURRENT) indicate Tin Plating What happens if dont use?

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4. Applications
a. Metal-based and ceramic restorations b. Posts, Post-cores c. Amalgam bonding (directions in lecture handout)

4. Applications
d. Resin-bonded fixed partial dentures (Maryland bridge)
Bond strength (stress)=Occlusal Force/Bonding Area 1) Reduced bonding area: Increased stress, higher bond strength required

e. Compromised retention restorations

1) Short, over-tapered crown (decreased area, decreased resistance form)

4. Applications
e. Compromised retention restorations 2) Long-span, high stress, fixed partial dentures a) FPD Flexibility length3 Double bridge length, 8x more flexible
i. As number of pontics between abutments increase, increased flexibility of FPD ii. Increased potential for restoration/cement breakdown b) Use high modulus metal (high rigidity) c) High bond strength cement

1. Resin cements not requiring DBA (Adhesive RC)

a. Used for compromised retention b. Minimal shade options, esthetics not primary consideration c. Multilink (Ivoclar), RelyX Unicem (3M ESPE), Panavia (Kuraray)

2. Resin cements requiring DBA (majority of RC)

a. Often shade options available, esthetic applications
1) Veneers, all-ceramic restorations

b. c. d. e.

Calibra (Dentsply), NT Prime & Bond Variolink II (Ivoclar), Syntac RelyX ARC (3M ESPE), Single Bond Many more DBA/RC products

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3. Higher bond strengths with adhesive RC

a. No DBA (Adhesive RC)
1) Panavia, RelyX Unicem: ~ 20 MPa 1) Variolink II, Calibra: ~ 20 MPa

b. DBA RC (esthetic, non-adhesive RC)

4. Applications 1. UMKC options:

a. Calibra, NT Prime & Bond b. Envision, Mirage bond agent

2. Try-in pastes

a. High strength (compromised retention) applications: use Adhesive RC/non-DBA cement b. Non-compromised retention situations: use DBA RC OR what is another cement option for alloy-based indirect restorations?

5. Cost: all expensive, $15-35/g

1. Premature occlusion Plan to use RMGI or resin cement What are the temporary cement options?

2. Pulpitis
3. Loosening of the restoration 4. Recurrent caries 5. Restoration incomplete seating
a. Often linked to other problems

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1. Cement viscosity; Pseudoplasticity 2. Restoration morphology

a. Onlay vs. crown: less force required

Luting agent

Tensile Strength (MPa)

Solubility
(% in 24h)

Dentin/Cement/Crown Bond Strength (MPa)

ZnPO4 GI RMGI Resin Cement (RC/DBA) Adhesive Resin Cement

5 6-7 15-25 35-40 35-40

0.2 max 0.4-1.5 0.07-0.40 0.15 0.15

0.5-1.5 3-5 ~5-10 ~15-20

(Dentin/DBA/RC/Crown)

3. Seating force: excess force leads to dentin rebound and potential restoration dislodgement

~20-30

Luting Agent Strengths

100 yrs clinical

Weaknesses
High solubility Low Strength Moisture
sensitivity

Application
Routine metalbased restorations

ZnPO4

experience Inexpensive

25 questions (2 pts each)

Routine metal-based
restorations

GI

>20 yrs clinical

experience

Low early MP P-op sensitivity

Multiple choice, short answer

RMGI

Medium strength Expansion Fluoride release Lower bond Low solubility strength Little p-op sens 20 yrs clinical
Multiple steps Expensive Difficult remove
excess

Routine metal-based
restorations

experience Resin cements Low solubility Good bond qualities

Metal-based, Ceramic Lab composites Posts, Cores Compromised retention

(Adhesive RC) Resin-bonded FPD (Adhesive RC) Amalgam bonding (Panavia)

Review: Blackboard materials List of Study Objectives in NOTES files

Occasional p-op
sensitivity

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