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Dental cements

Dr. Hamida khatun


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) Lutting cements:
Zn phosphate cement.
ZOE cement.
Zink polycarboxylate cement.
Glass inomer cement.
Resin modified glass inomer 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 vernishes:
It is composed of natural gums such as copal resin or synthetic resin dissolved in an organic
solvent(aceton ,chloroform or etrer).It is indicated for amalgam restoration but not indicated
GICs and resin based composite.
b. Cavity liners:
Calcium hydroxide
Low viscosity ZOE
Glass Inomer
Resin cement(Flowable Composite)
MTA
3. Cement Bases:
Zn phosphate
ZOE cement
Calcium hydroxide
Polycarboxilate cement
Glass inomer cement
MTA
(5).Cement For Restoretives:
Zn polycarboxylate cement
Zn phosphate cement
Glass inomer cement
Metal reinforced glass inomer cement(Silver alloy powder or particles of silver sintered to glass that
make the cement grayish and more radiopaque)
High viscosity glass inomer cement.
Resin modified glass inomer 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 inomer cement
Resin modified glass inomer
Compomer
Glass inomer cements:
Composition:
Powder : Acid soluble calcium fluoroaluminosilicate glass
Liquid: Polyacrylic acid
Setting Reaction of Glass inomer:
• 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 inomer cements are known chemical adhesives to tooth
structure.GIC involves chelation of carboxyl groups of the
polyacrylicacids with the calcium appetite of the enamel and
dentin.The bond strength to enamel is greater than that of dentin.
Newer classification of GICs:
1.Traditional Glass inomer
A. Type I: Luting cement
B. TYPe II: Restorative Cements
C. TypeIII: Liners and Bases
2. Metal Modified Glass inomer
A. Miracle Mix.
B. Cermet Cement
3. Light cure Glass Inomer
4. Hybrid or Resin Modified Glass Inomer
a. Composite resin in which fillers substitute with glass inomer
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.Fluride 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 inomer 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 anterion teeth.
Zinc phosphate cement:
Powder:
75% zinc oxide
13% magnesium
Liquid:
Phosphoric acid (38– 59%)
Water(30—55%)
Aluminum phosphet (2—3)
Zn phosphet (upto 10%)
Properties of zinc phosphet cement:
Strength depends on powder and liquid ratio. Zinc phosphet cement achieves 75% of
its ultimate strength within 1 hour.
Compressive strength of cement is 104 Mpa.
Tensile strength 5.5 Mpa.
Modulus of elasticity is 13.7 gigapascals.
Retention of cement by mechanical interlocking.
Because of presence of phosphoric acid, acidity of cement is quite high making it
irritable.
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:
Lutting agent for crowns, inlay.
Intermediate base.
Temporary restoration.
Lutting 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.
Soluable 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 restarations,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
i. Using chilled glass slab.
ii. Using smaller increments for initial mixing of cement.
iii.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 phosphet cement
probably occurs during the first few hours after insertion.
• Mixing cements I 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
aluminophosphate gel.
• The set cement consists of a zinc phosphate matrix in which
unreacted zinc oxide powder particles are embeded.Crystals of
tertiary zinc phosphate are found on the surface of the cement.
Zinc oxide eugenol cement:
Zno eugenol cements is 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
White resin—29.3% reduces brittleness
Zinc stearate– 1% catalyst
Zinc acetate(acts as accelerator)-- .7% Accelerator
Liquid
Eugenol– 85% Reactor
Olive oil—15% plasticizer.
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 soluable cements.To increase the
strength of the set material, changes in composition can be made to
the powder and liquid.For example, orthoethoxybenzoic 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 bacteriocidal.
They have very low thermal conductivity.
They set even in presence of moisture.
Uses of zno eugenol cement:
As a cavity liner, specially in a deep cavity.
As a temporary filling material.
As a sedative dressing particularly in sensitive dentine.(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 abbestos 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.