Dental Cements

Dental materials

Uses of dental cements

Pulpal protection (liners, bases, varnishes) Luting cementation (crowns, inlays, onlays veneers) Restorations (temporary and permanent) Surgical dressing (e.g. periodontal surgery)

Pulpal protection

Pulpal irritation can result from:

Dental caries Chemicals in restorative material Cutting of tooth structure Thermal conductivity of metal restorations
Cavity varnishes Liners bases

Pulpal protection is achieved by using:

Pulpal protection

Cavity varnish: a thin layer placed on the floor and wall of the cavity to seal dentinal tubules and minimize microleakage.

Composition:

Natural resin (copal) Synthetic resin dissolved in solvent such as alcohol or chloroform.

Cavity varnish

Application method:

The varnish is applied in a thin layer The solvent evaporates within 5 15 seconds A second layer is applied The resin component protects pulp by:

Sealing dentinal tubules Reducing microleakage Reduce staining

Dispensing and clinical considerations

2 bottles:

Varnish: 90% solvent, 10% resin (copal) Solvent to dilute varnish if solvent evaporates The lid should be kept tightly closed

Varnishes have been largely replaced by bonding agents since varnishes wash out quickly Disrupted by resin monomers, not used under therapeutic base
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Liners/low strength base

Calcium hydroxide, ZnO/E (Type IV) Calcium Hydroxide: Clinical uses:

Liner to protect pulp Direct and indirect pulp capping Self-cured:

Dispensing: 2 paste system

Base: Calcium phosphate, calcium tungstate, Zinc oxide, Glycol salicylate Catalyst: Calcium hydroxide, zinc oxide, zinc stearate in ethylene toluene sulfonamide

Light cured cement: UDMA + Ca hydroxide + barium sulfate filler and low viscosity monomer
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Properties of Calcium hydroxide

Set cement is calcium disalicylate Properties:

Has an alkaline Ph 9-11(stimulates dentine formation) Setting time: 2-7 minutes Weak compressive strength Thermal insulator High solubility

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Low strength bases

ZnO/Eugenol: Type IV Uses:

Pulpal protection in deep cavities Weak Sedative effect Little thermal insulation since its used in thin layers

Properties:

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High strength base

Function:

Insulator Support for restoration

Mixing: mixed into a thick putty like consistency (secondary consistency) that can be rolled into a ball or rope. Placed in a 0.5-0.75 mm thick layer or greater

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High strength bases

Materials used:

GIC Resin modified-GIC Polymer reinforced ZnO/E (Type III)

High strength that develop quickly Low thermal conductivity Moderate elastic modulus

Properties required for high strength bases:

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Luting cements

Desirable features:

Good wettability Good flow Thin film thickness: 25 m or less to fill the space between tooth structure and restoration. It will prevent proper seating of restoration Excess cement may wash out and cause irritation and caries

If the luting agents layer is too thick:

Mixed to primary consistency: less viscous, flows easily, can be drawn to 1 inch string with spatula lifted from center of mass
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Restorations

Permanent: cements are rarely used as restorations due to:

Low strength Low wear resistance High solubility

The exception is GIC, used for class V cavities and primary teeth.

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Restorations

Temporary and intermediate restorations:

Cements are mixed to secondary consistency Uses: If time is insufficient to place permanent restoration In symptomatic teeth, a sedative provisional restoration can be placed Between visits in cases of Endodontic treatment, crowns, inlays
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Surgical dressing

Purpose for using cements as dressing:

Protection and support of surgery site Help to control bleeding Provide comfort for patient

Material used: non eugenol dressing, mixed to soft putty like consistency. A good dressing should be:

Smooth and not too bulky Covers surgery site with minimal overextension Interlocks interdentally to provide retention

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Properties of dental cements

Strength
Solubility

Depends on P:L. Brittle, C.S, T.S. Resin cements > polycarboxylate cements
Influenced by powder ratio. Cements have solubility microleakage & pulpal irritation, except resin Affects luting agents. To get secondary consistency, powder pH of cement. Cements containing eugenol are sedative. Fluoride caries Chemical (GIC). Micromechanical with luting agents penetrating irregularities.

Viscosity Biocompatibility Retention

Esthetics

Shades for luting agents for veneers & anterior crowns. Opaque cement to mask dentine discoloration. Try in paste available
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Manipulation

Mixing Loading the restoration Removal of excess cement Cleanup, disinfection and sterilization Consideration during instrumentation

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Mixing

Follow manufacturer instruction Consider working time of the cement according to clinical application. Example:

Long span bridge VS. one crown Areas of difficult isolation Patient consideration Mixing skills of dentist or dental assistance

Setting: chemical, light or dual cure.

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Removal of excess

Some cements should be removed when rubbery others need to be removed when tacky

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Zinc oxide eugenol

Uses:

Low/high strength base Temporary and Intermediate restoration Temporary cementation Root canal sealers Periodontal dressings New reinforced cements are used for permanent cementation (Type II)

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Composition and properties

Composition:

Type I: Zinc oxide, eugenol, rosin to reduce brittleness, zinc acetate as accelerator Type II:

20% Acrylic resin is added as reinforcing agent Ethoxybenzoic acid (EBA)-alumina-reinforced cement contains 30% alumina in powder. Liquid is eugenol and EBA to form stronger crystalline matrix

Newer cements are eugenol free Dispensed as powder & liquid, and two paste system

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Properties:

Sedative effect on pulp and antibacterial Alkaline pH (=7), biocompatible Can be irritant if in direct contact with pulp Eugenol interferes with setting of resin Moderate strength Retention is mechanical Water and temperature increase accelerate setting

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Manipulation

Type I: two paste system, mixed until uniform color Solvent: oil of orange Type II: powder and liquid, powder in immediately incorporated into liquid ad mixed (30 seconds) yielding putty consistency, additional 30 sec. mixing provide fluid consistency.

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Zinc oxide eugenol

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Zinc phosphate

Used to be used as a permanent luting agent Composition:

Powder: zinc oxide Liquid: phosphoric acid and water buffered by Al + Zn to slow setting

Setting reaction: exothermic, controlled by incremental incorporation of powder into liquid. Cement is porous.

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Properties

Initial acidity with pH of 4.2, becomes neutral after 48 hours. Retentive by mechanical retention sandblasting of crowns or inlays Similar strength to GIC, high CS, low tensile strength. Low solubility once set

Fast setting Moisture adversely affects cement

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Manipulation

Powder is dispensed and divided into 4-6 portions Liquid is dispensed according to manufacturer Mixing is gradual at 15 seconds intervals for 60-120seconds Large strokes over a large area

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Zinc polycarboxylate

Uses:

High strength base Final cementation of indirect restorations

Composition:

Powder: zinc oxide Liquid: polyacrylic acid

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Properties:

Lower compressive strength than other cements Mild acidity Higher viscosity when mixed but reasonable flow Liquid should not be dispensed before needed, to avoid water evaporation and viscosity Retention is chemical and mechanical To increase working time use a cold slab

Manipulation: powder liquid systems, 90% of powder added first then the rest is mixed with liquid to adjust consistency

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Glass ionomer cements

Composition and reaction explained previously Uses:

low/high strength bases (in deep cavities use calcium hydroxide instead) Luting agents Core build up Restorative material (e.g. class V)

Manipulation?
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Resin modified-GIC

Uses: Permanent cementation of crowns and bridges Core build up Liners Bonding of orthodontic brackets Properties: Fluoride release Low solubility once set Early low pH then increases High fracture toughness but lower than resin cements Problem of water sorption (contraindicated for all-ceramic restorations, may cause cracking due to expansion) Manipulation: capsules, powder liquid systems?

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Resin-based cements

They are modified composites used for:

Bond ceramic indirect restorations Bond conventional crowns and bridges Bonding of orthodontic bands Temporary cementation Chemical cure Light cure Dual cure: most versatile
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Setting:

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Composition and properties

Similar to composite resin Microfill or microhybrid Properties:

Insoluble and high wear resistant High bond strength when primer is used Good esthetic under all-ceramic crowns Bonded by etching and bonding, sandblasting of internal surface of restoration Temporary cements: easy to mix and clean up, lowmedium strength New self adhesive resin: no etching or priming needed (Relyx Unicem, 3M ESPE).

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Compomer cements

Uses: PFM bridges and crowns Composition and reaction:

Powder: fluorosilicate glass, sodium fluoride, self-cured and light-cured initiators Liquid: polymerized-methacrylate-carboxylic acid monomer, water, acrylate-phosphate monomer, diacrylate monomer Fluoride release, low solubility, high bond strength, high fracture toughness and strength

Properties:

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Manipulation

Paste-paste system Powder-liquid system: rapid mixing is needed Dry but not desiccated tooth surface Gelation after 1 minutes, here excess is removed Margins are light-cured

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Special applications of cements

Bonding of orthodontic brackets:

Resin cements Hybrid ionomers Film thickness should be less than 0.25 mm Glass ionomer Zinc phosphate with added fluoride Hybrid ionomers Resin cements

Cementation of orthodontic bands:

Root canal sealers: zinc/O based or Ca hydroxide. Should be biocompatible, radiopaque, long working time
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Reference: Dental Materials, properties and manipulation

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