Dental Cements

Dr. Hamida khatun

ROLL:
Dental Cements:
Dental cements are materials that set intraorally, and that are commonly used to join a tooth
and a prosthesis or restoration of carious tooth. They are classified according to their major
chemical reacting components.
Classification of Dental cements:
(1) Luting cements:

 Zn phosphate cement.
 ZOE cement.
 Zink polycarboxylate cement.
 Glass ionomer cement.
 Resin modified glass ionomer cement
 Compomer cement.
 Resin cement.
(2) Cements for pulp protection:
cavity varnishes, cavity liners and cement bases are used as pulp protection cements.
a. Cavity varnishes:
It is composed of natural gums such as copal resin or synthetic resin dissolved in an
organic solvent (acetone, chloroform or ester). It is indicated for amalgam restoration
but not indicated GICs and resin based composite.
b. Cavity liners:

 Calcium hydroxide
 Low viscosity ZOE
 Glass Ionomer
 Resin cement (Flowable Composite)
 MTA
(3) Cement Bases:

 Zn phosphate
 ZOE cement
 Calcium hydroxide
 Polycarboxylate cement
 Glass ionomer cement
 MTA
(5) Cement for Restoratives:

 Zn polycarboxylate cement
 Zn phosphate cement
 Glass ionomer cement
 Metal reinforced glass ionomer cement (Silver alloy powder or particles of silver sintered to
glass that make the cement grayish and more radiopaque)
 High viscosity glass ionomer cement.
 Resin modified glass ionomer cement
 Compomer
 Resin cement
 Zn-oxide eugenol cement
 Mineral Trioxide Aggregate cements.

(6) Root Canal sealer:

 ZOE based sealer

 Epoxy based sealer
 Calcium based sealer
 MTA based sealer

(7) Calcium phosphate Cement

(8) Fluoride Releasing Material:

 Glass ionomer cement

 Resin modified glass ionomer
 Compomer

Setting Reaction of Glass ionomer:

• Powder and liquid are mixed together.

• Acid attacks the glass particles leaching calcium, aluminium, sodium and fluoride ions into the
aqueous medium.

• Polyacrylic acid chains- cross- linked by the aluminium ions which is further replaced by calcium
ions-24 hours.

• Sodium and fluoride ions from the glass do not participate in the cross linking.

• The cross- linked phase becomes hydrated over time as it matures.

• Undissolved portion of glass particles is sheathed by a silica- rich gel.

Adhesion of GICs with tooth:

• Glass ionomer cements are known chemical adhesives to tooth structure. GIC involves chelation
of carboxyl groups of the poly-acrylic acids with the calcium apatite of the enamel and dentin.
The bond strength to enamel is greater than that of dentin.
Newer classification of GICs:
1.Traditional Glass ionomer
a. Type I: Luting cement
b. Type II: Restorative Cements
c. Type III: Liners and Bases
2. Metal Modified Glass ionomer
a. Miracle Mix.
b. Cermet Cement
3. Light cure Glass Ionomer
4. Hybrid or Resin Modified Glass Ionomer
a. Composite resin in which fillers substitute with glass ionomer particles.
b. Pre- cured glass blended into composite.
Other Classification:
Type I: For luting
Type II: For restoration
Type III: For liner and bases.
Type IV: Pit and fissure Sealant.
Type V: As orthodontic Cement
Type VI: For core build up.
Physical properties:
1. Low solubility
2. Coefficient of thermal expansion similar to dentin
3. Fluoride release and fluoride recharge.
4. High compressive strengths
5. Bonds to tooth structure.
6. Low Flexural Strength
7. Low shear Strength
8. Dimensional Change (slight expansion) (Shrinks on setting, expands with water absorption)
9. Brittle
10. Lacks translucency
11. Rough surface texture
Indication of glass ionomer cement:
A. Restoration of permanent tooth:

 Class V, class III, small class I Tooth preparations

 Abrasion/Erosion
 Root caries.
B. Restoration of deciduous teeth

 Class I to class VI tooth preparations

 Rampant and nursing bottle caries
C. Luting or cementing

 Metal restorations (Inlay, onlay and crowns)

 Veneers
 Pins and posts
 Orthodontic bonds and brackets.
D. Preventive restoration:

 Tunnel preparation.
 Pit and fissure sealants
E. protective liner under composite and amalgam

 Bonding agent
 Dentin substitute
 Core build up
 Splinting
F. Endodontics

 Repair of external root resorption

 Repair of perforation
 Atraumatic restorative treatment
 Bonded restoration
Contraindication:

 In stress bearing areas like class I, class II and class IV preparations

 In cuspal replacement cases.
 In patient with xerostomia
 In mouth breathers because restoration may become opaque, brittle and fracture over a
time
 In areas requiring esthetics like veneering of anterior teeth.
Zinc phosphate cement:
Powder: Liquid:

 75% zinc oxide  Phosphoric acid (38– 59%)

 13% magnesium  Water (30—55%)
 Aluminum phosphate (2—3)
 Zn phosphate (upto 10%)
Properties of zinc phosphate cement:
a. Strength depends on powder and liquid ratio. Zinc phosphate cement achieves 75% of
its ultimate strength within 1 hour.
b. Compressive strength of cement is 104 MPa.
c. Tensile strength 5.5 MPa.
d. Modulus of elasticity is 13.7 gigapascals.
e. Retention of cement by mechanical interlocking.
f. Because of presence of phosphoric acid, acidity of cement is quite high making it
irritable.
g. PH of cement liquid is 2. Two minutes after mixing, the pH is almost 2 and after 48
hours, it is 5.5.
Uses of zinc phosphate cement:
a. Luting agent for crowns, inlay.
b. Intermediate base.
c. Temporary restoration.
d. Luting orthodontic bands.
Advantages:

 Long record of clinical acceptability.

 High compressive strength.
 Thin film thickness.
Disadvantages:

 It is irritable to the pulp tissue.

 Lack of adhesion to the tooth structure.
 Soluble in water
Some important properties of zinc phosphate cement:

• This cement mixing should be done on cool glass slab with a narrow bladed stainless steel
spatula. Lower the temperature of the slab during mixing, the longer will be the working time.
This is advantageous because it allows incorporation of more powder into the liquid which
results in greater compressive strength and lower solubility of the final cement. For the same
powder liquid ratio and mixing technique, the cement prepared on a cool slab is still fluid and
suitable for cementation of cast restorations, whereas the mix made on a slab at room
temperature may be too viscous for use in cementing precision casting.

• Some clinicians prefer to mix the cement using the frozen slab technique which greatly extends
the working time and allows incorporation of more powder into the liquid. But this method has
disadvantage of incorporating water into the mix.

• Since setting reaction is an exothermic type, the heat liberated while setting further accelerates
the setting rate. So, it is very important to dissipate this heat which can be done by

a. Using chilled glass slab.

b. Using smaller increments for initial mixing of cement.

c. Mixing the large area of glass slab,

• As might be expected from the presence of the phosphoric acid, the acidity of zinc phosphate
cement is quit high at the time when a prosthesis is placed on a prepared tooth. Two minute
after the start of the mixing, the pH of the cement is approximately 2.The pH then increases
rapidly, but still is only about 5.5 at 24 hours. From this data it is evident that any damage to the
pulp from acid attack by zinc phosphate cement probably occurs during the first few hours after
insertion.

• Mixing cements increments and introducing smaller quantities of powder into the liquid for the
first few increments increase the working and setting times and permits more powder to be
incorporated into the mix. These steps are consistent with the recommended procedure for
mixing zinc phosphate cement.

• If an operator prolongs the spatulation of the last increment, the matrix will be effectively
destroyed as it forming. Fragmentation of the matrix means the extra time is needed to rebuild
the bulk of the matrix. This is different from the phenomenon observed for the dental stones, in
which a fragmented matrix represents new nuclei for crystallization that control the setting time
and microstructure of the gypsum product.

Setting reaction of phosphate cement:

• Phosphoric acid attacks surface of the particles and releases Zn ions into the liquid. Aluminum
which already forms a complex with the phosphoric acid and reacts with zinc and yields a zinc
alumino-phosphate gel.
 • The set cement consists of a zinc phosphate matrix in which unreacted zinc oxide powder
particles are embedded. Crystals of tertiary zinc phosphate are found on the surface of the
cement.

Zinc oxide eugenol cement:

• ZnO eugenol cements are one of the oldest used cement. It has soothing action on
pulpal tissues and eugenol has topical anesthetic properties, therefore it is also termed
as an obtundent material. Though other cements are also used for temporization, but
zinc oxide-cement is used most commonly because it is much less irritating to pulp and
produce better marginal seal than zinc phosphate. A thick mix of zinc oxide eugenol
cement is used for small cavities but before placing the cement, the prepared cavity
must be isolated and cleaned.
• Zinc oxide eugenol is not used as base material especially when unfilled and filled
resins are used as restorative materials because eugenol interferes with polymerization
process of resins. In these cases, calcium hydroxide is used as a base material under
resin restoration.
Composition:
Powder:
• Zinc oxide (ZnO)—69% reactive ingredient Liquid:
• White resin—29.3% reduces brittleness • Eugenol– 85% Reactor
• Zinc stearate– 1% catalyst • Olive oil—15% plasticizer.
• Zinc acetate (acts as accelerator) --- 0.7%
Accelerator
Setting Reaction of zinc Oxide Eugenol cement
• On mixing powder and liquid, the zinc oxide hydrolysis and subsequent reaction takes
place between zinc hydroxide and eugenol to form a chelate, zinc eugenolate. Within
this matrix unreacted zinc oxide powder particles are embedded.
First reaction………....Zno+H2O ---- Zn(OH)2
Second Reaction…… Zn(OH)2+2HE---ZnE2+2H2O
• Water is needed for the reaction and it is also by product of the reaction. So, reaction
progresses more rapidly in humid conditions.
• Because zinc eugenolate rapidly hydrolyzes to form free eugenol and zinc hydroxide, it is
one of the most soluble cements. To increase the strength of the set material, changes
in composition can be made to the powder and liquid. For example, ortho-ethoxy-
benzoic acid can be added to the liquid or alumina or polymethyl meth acrylate powder
can be added to the powder. These modified zinc oxide– eugenol cements
Properties:
• They are bactericidal.
• They have very low thermal conductivity.
• They set even in presence of moisture.
• Uses of ZnO eugenol cement:
• As a cavity liner, especially in a deep cavity.
• As a temporary filling material.
• As a sedative dressing particularly in sensitive dentin. (Deep cavity, dry socket, etc.)
• In filling root canal along with G.P. point.
• As a periodontal pack in the treatment of acute in the treatment of acute
inflammatory conditions of the gum.
• It is also used in the treatment of odontalgia (tooth-ache).
• It is used as an insulating base for permanent metallic restoration.
• It is used as a surgical pack in combination with asbestos fibres and cotton wool after
the operation of gingivectomy.
• It is used as filling material of the deciduous tooth.
Advantages of ZOE cement
• Soothing effect on the pulp
• Good short time sealing.
Disadvantages:
• Highly soluble
• Low strength
• Long setting time
• Low compressive strength.