Advanced Cementation Update       Webinar
Clinical Mastery    (www.clinicalmastery.com)Over-the-shoulder Prepless veneer coursesFull mouth rehabilitation courses...
Webinar   October 14thThe Why, Where, & When  of bite relationships     John Nosti, DMD   www.clinicalmastery.com
david@hornbrook.com
CementationAdhesion “total-etch”, resin cementSemi-adhesion Self-etching resin cementNon-adhesion Glass Ionomer, res...
Cement RequirementsLack of post-operative sensitivityStrong bond and good seal  -to the tooth and to the restorative mat...
“Total-etch”           with  Resin Cement  Powder liquid ceramic             orPressed ceramic restorations
“Tack &   Wave”CementationVeneers and anterior crowns
Emprethin evaluation
Be Careful!!!0.2 mm glass is fragile!
OptraGate   (Ivoclar)
Hydrogen Peroxide in Ultradent Syringe
Metal strip removes any interproximal Luxatemp and freshens the enamel
Try in independently        DRY
Occlude Spray Powder(Pascal)
Try-in collectively DRY!   Check complete seating   Proximal contacts
Mesial SurfaceDry Erase Marker
DistalSurface
Variolink Veneer    (Ivoclar/Vivadent)    Value based    0    +1, +2, +3    -1, -2, -3    Microfill
0   +2
Clean and acidify with 35% Phosphoric acid
Silane Coupling Agent (Relyx Ceramic primer) placed for 1 minute
Place bonding agent (All Bond 3) inside dry restoration
Load restoration with resin cement
Vivapad (Ivoclar)
Etch with 35% phosphoric acid for 15 seconds per tooth
Apply Systemp desensitizer for 15 seconds
Effect of RemoisteningWater vs. Desensitizer/RewettingProduct             Agent                 Dentinal BondWater-blotted...
suction” away excess; do not desiccate
Apply 2 coats of All Bond 3 A & B Primer mix
Adec Warm Air Tooth Dryer
Seat all restorations at one time; do not remove               excess resin cement
Polymerize “dead center” each restoration for1 second using a 2.0 mm light guide (Ivoclar)
H old light guide 1 inch from restorationsand light cure 3-5 seconds on facial and lingual
General Guidelines   +2: 5 seconds   0: 3 seconds   -3: 5 seconds +
“ Pick" away excess using Bard Parker or scaler
Floss through contacts using a Brasseler Serrated Saw
Floss through contacts using waxed dental floss
Place DeOx (Ultradent) on all margins
Light polymerize for at least 60 seconds per tooth from both buccal and lingual
Curing LightsPhotoinitiators Camphoroquinone- 470-490 nm PhenylDipropandione- 430 nm
PDP 430 nm         CQ 488 nm40302010 0                                          CQ     300    350   400   450     500   60...
OptiLux 501  (Demetron)Emits light with wavelength        390-510 nm
PDP 430 nm         CQ 488 nm40302010 0                                          CQ     300    350   400   450     500   60...
LED Light i.e.. Freelight (3M), LEDemetron(Kerr),,BluPhase (Ivoclar), DEMI (Kerr)…       -No bulb degradation             ...
PDP 430 nm         CQ 468 nm40302010 0                                          CQ     300    350   400   450     500   60...
Emits light with wavelength        390-510 nm BluePhase G2   (Ivoclar)
Fusionwww.dentlight.com
Remove excess resin cement with Scaler,   #12 & #15 Bard-parker Blades
Run Serrated Saw through contacts
1954N Strip (3M)
Epitex Strips (GC)
15 micron finishing diamond (Brasseler))
15 micron football-shaped diamond on lingual
OptraFine Porcelain polishing system (Ivoclar)
DiaShine ( V & H )
Solid Model Contacts
Adhesion to the   restorationCeramist etches in labClinician cleans internal surfaces with phosphoric acidRinse and dry...
Adhesion to the   restorationCeramist etches in labClinician cleans internal surfaces with phosphoric acidRinse and dry...
Blot Dry dentin
Apply primer
Air dry primer
ight polymerize for 10 seconds
PosteriorRelyX ARC (3M)
Hold passively for 3 minutes
Remove excess with scaler or explorer
Floss through contacts
Cover margins withoxygen-inhibiting medium
Light polymerize for at least 60 seconds
Use scaler and/or#12 Bard Parker
re-reinforced Restorations       Zirconia       Alumina        MetalLithium disilicate (e.Max)
Pressed Ceramic/      “Core” reinforced ceramicPowder-liquid ceramics( Metal, zirconium, lithium disilicate, alumina oxide...
e.Max Pressed Lithium disilicate pressed
“Core” reinforced ceramic   ( Metal, zirconium, lithium disilicate, alumina oxide )   Conventional cementsZinc phosphate,...
“Core” reinforced ceramic etal, zirconium, lithium disilicate, alumina oxi            No etch adhesive cements Resin Modi...
“ Self-adhesive”           resin cements (the benefits of resin without the technique sensitivity)Single component Self-Ad...
ingle Component Self-adhesive “ cemen       Unicem (3M)       MaxCem Elite (Kerr)      Embrace       Embrace Wetbond ( ...
ingle Component Self-adhesive “ cemen         BisCem      Embrace                    (Bisco)
ingle Component Self-adhesive “ cemen                 Bond strengths (Reality)                    Dentin                  ...
Advantages ofSingle Component self-adhesive” cement  Good physical properties  Some adhesive properties    Very, very e...
Disadvantages ofSingle Component self-adhesive” cement    Mediocre bonds to dentin and               enamel   Questionab...
ssisted “Self-etch” resin cement       Panavia FL2.0            (Kuraray)        Bistite II DC           (J. Morita)     M...
Advantages of    Assisted “Self-adhesive” cements       Good physical properties       Good adhesive properties Easier ...
Assisted “Self adhesive” cements                Bond strengths (Reality)                   Dentin                  Enamel ...
Disadvantages ofAssisted “Self-adhesive” cements Involves an adhesive step Bonds not as strong as     “Total-etch”
Can we “etch “with phosphoric acid with self-etch cements?Enamel Bonds Total-etch             Self-etch Panavia F 2.0     ...
When do I use what?Non-core supported ceramic: “Total etch”Core-supported Ceramic Minimal retention and resistance for...
Hornbrook 2009 Updates –           Full Day EventsTopics include:•2009 Materials Update•My top 10 failures and how YOU can...
Anterior cementation technique guide
Anterior cementation technique guide
Anterior cementation technique guide
Anterior cementation technique guide
Anterior cementation technique guide
Anterior cementation technique guide
Anterior cementation technique guide
Anterior cementation technique guide
Anterior cementation technique guide
Anterior cementation technique guide
Anterior cementation technique guide
Anterior cementation technique guide
Anterior cementation technique guide
Anterior cementation technique guide
Anterior cementation technique guide
Anterior cementation technique guide
Anterior cementation technique guide
Anterior cementation technique guide
Anterior cementation technique guide
Anterior cementation technique guide
Anterior cementation technique guide
Anterior cementation technique guide
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Anterior cementation technique guide

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Anterior cementation technique guide

  1. 1. Advanced Cementation Update Webinar
  2. 2. Clinical Mastery (www.clinicalmastery.com)Over-the-shoulder Prepless veneer coursesFull mouth rehabilitation coursesHands-on Occlusion CoursesWebinars Phoenix, Arizona
  3. 3. Webinar October 14thThe Why, Where, & When of bite relationships John Nosti, DMD www.clinicalmastery.com
  4. 4. david@hornbrook.com
  5. 5. CementationAdhesion “total-etch”, resin cementSemi-adhesion Self-etching resin cementNon-adhesion Glass Ionomer, resinionomer, zinc phosphate, polycarboxylate
  6. 6. Cement RequirementsLack of post-operative sensitivityStrong bond and good seal -to the tooth and to the restorative materialEasy placement and clean-upEsthetics compatible with the restorative materialMinimal film thicknessRadiopaque (posterior)
  7. 7. “Total-etch” with Resin Cement Powder liquid ceramic orPressed ceramic restorations
  8. 8. “Tack & Wave”CementationVeneers and anterior crowns
  9. 9. Emprethin evaluation
  10. 10. Be Careful!!!0.2 mm glass is fragile!
  11. 11. OptraGate (Ivoclar)
  12. 12. Hydrogen Peroxide in Ultradent Syringe
  13. 13. Metal strip removes any interproximal Luxatemp and freshens the enamel
  14. 14. Try in independently DRY
  15. 15. Occlude Spray Powder(Pascal)
  16. 16. Try-in collectively DRY! Check complete seating Proximal contacts
  17. 17. Mesial SurfaceDry Erase Marker
  18. 18. DistalSurface
  19. 19. Variolink Veneer (Ivoclar/Vivadent) Value based 0 +1, +2, +3 -1, -2, -3 Microfill
  20. 20. 0 +2
  21. 21. Clean and acidify with 35% Phosphoric acid
  22. 22. Silane Coupling Agent (Relyx Ceramic primer) placed for 1 minute
  23. 23. Place bonding agent (All Bond 3) inside dry restoration
  24. 24. Load restoration with resin cement
  25. 25. Vivapad (Ivoclar)
  26. 26. Etch with 35% phosphoric acid for 15 seconds per tooth
  27. 27. Apply Systemp desensitizer for 15 seconds
  28. 28. Effect of RemoisteningWater vs. Desensitizer/RewettingProduct Agent Dentinal BondWater-blotted dry 22.8Water- wet 19.2Gluma Desensitizer 22.3HurriSeal 20.1Vivadent Desensitizer 25.8MicroPrime 20.1Aqua-Prep 18.1
  29. 29. suction” away excess; do not desiccate
  30. 30. Apply 2 coats of All Bond 3 A & B Primer mix
  31. 31. Adec Warm Air Tooth Dryer
  32. 32. Seat all restorations at one time; do not remove excess resin cement
  33. 33. Polymerize “dead center” each restoration for1 second using a 2.0 mm light guide (Ivoclar)
  34. 34. H old light guide 1 inch from restorationsand light cure 3-5 seconds on facial and lingual
  35. 35. General Guidelines +2: 5 seconds 0: 3 seconds -3: 5 seconds +
  36. 36. “ Pick" away excess using Bard Parker or scaler
  37. 37. Floss through contacts using a Brasseler Serrated Saw
  38. 38. Floss through contacts using waxed dental floss
  39. 39. Place DeOx (Ultradent) on all margins
  40. 40. Light polymerize for at least 60 seconds per tooth from both buccal and lingual
  41. 41. Curing LightsPhotoinitiators Camphoroquinone- 470-490 nm PhenylDipropandione- 430 nm
  42. 42. PDP 430 nm CQ 488 nm40302010 0 CQ 300 350 400 450 500 600 Wavelength (nm)
  43. 43. OptiLux 501 (Demetron)Emits light with wavelength 390-510 nm
  44. 44. PDP 430 nm CQ 488 nm40302010 0 CQ 300 350 400 450 500 600 Wavelength (nm)
  45. 45. LED Light i.e.. Freelight (3M), LEDemetron(Kerr),,BluPhase (Ivoclar), DEMI (Kerr)… -No bulb degradation -Portable-Wavelength output 450-500 nm
  46. 46. PDP 430 nm CQ 468 nm40302010 0 CQ 300 350 400 450 500 600 Wavelength (nm)
  47. 47. Emits light with wavelength 390-510 nm BluePhase G2 (Ivoclar)
  48. 48. Fusionwww.dentlight.com
  49. 49. Remove excess resin cement with Scaler, #12 & #15 Bard-parker Blades
  50. 50. Run Serrated Saw through contacts
  51. 51. 1954N Strip (3M)
  52. 52. Epitex Strips (GC)
  53. 53. 15 micron finishing diamond (Brasseler))
  54. 54. 15 micron football-shaped diamond on lingual
  55. 55. OptraFine Porcelain polishing system (Ivoclar)
  56. 56. DiaShine ( V & H )
  57. 57. Solid Model Contacts
  58. 58. Adhesion to the restorationCeramist etches in labClinician cleans internal surfaces with phosphoric acidRinse and dry thoroughlyApply Silane coupling agentApply dual-cure adhesive resin to internal of restoration
  59. 59. Adhesion to the restorationCeramist etches in labClinician cleans internal surfaces with phosphoric acidRinse and dry thoroughlyApply Silane coupling agentApply dual-cure adhesive resin to internal of restoration
  60. 60. Blot Dry dentin
  61. 61. Apply primer
  62. 62. Air dry primer
  63. 63. ight polymerize for 10 seconds
  64. 64. PosteriorRelyX ARC (3M)
  65. 65. Hold passively for 3 minutes
  66. 66. Remove excess with scaler or explorer
  67. 67. Floss through contacts
  68. 68. Cover margins withoxygen-inhibiting medium
  69. 69. Light polymerize for at least 60 seconds
  70. 70. Use scaler and/or#12 Bard Parker
  71. 71. re-reinforced Restorations Zirconia Alumina MetalLithium disilicate (e.Max)
  72. 72. Pressed Ceramic/ “Core” reinforced ceramicPowder-liquid ceramics( Metal, zirconium, lithium disilicate, alumina oxide) High technique sensitivity  “Total-  Conventional cements etch” resin  No etch Adhesive cements cements
  73. 73. e.Max Pressed Lithium disilicate pressed
  74. 74. “Core” reinforced ceramic ( Metal, zirconium, lithium disilicate, alumina oxide )  Conventional cementsZinc phosphate, polycarboxylate, Glass ionomer)  No etch Adhesive cements (Resin-ionomers, self-adhesive resin cemen
  75. 75. “Core” reinforced ceramic etal, zirconium, lithium disilicate, alumina oxi No etch adhesive cements Resin Modified glass ionomers (FujiCem, FujiPlus, RelyX Luting)  Self-adhesive resin cements (Unicem, MaxCem, Multilink Automix, Panavia F
  76. 76. “ Self-adhesive” resin cements (the benefits of resin without the technique sensitivity)Single component Self-Adhesive (Unicem, MaxCem, others)  Assisted Self-adhesive resin cemen (Multilink Automix, Panavia FL)
  77. 77. ingle Component Self-adhesive “ cemen Unicem (3M) MaxCem Elite (Kerr) Embrace Embrace Wetbond ( Pulpdent) G-Cem (GC) BisCem (Bisco)
  78. 78. ingle Component Self-adhesive “ cemen BisCem Embrace (Bisco)
  79. 79. ingle Component Self-adhesive “ cemen Bond strengths (Reality) Dentin Enamel Embrace MaxCem 3.8 8.8 Unicem 7.7 16.6 BisCem 9.0 15.0 “Total-etch” 30.3 25.4 Relyx
  80. 80. Advantages ofSingle Component self-adhesive” cement  Good physical properties  Some adhesive properties  Very, very easy to use
  81. 81. Disadvantages ofSingle Component self-adhesive” cement  Mediocre bonds to dentin and enamel Questionable long term enamel bonds  Questionable bonds to restorative substrate
  82. 82. ssisted “Self-etch” resin cement Panavia FL2.0 (Kuraray) Bistite II DC (J. Morita) Multilink Automix ( Ivoclar)
  83. 83. Advantages of Assisted “Self-adhesive” cements  Good physical properties  Good adhesive properties Easier to use than “Total-etch” cement
  84. 84. Assisted “Self adhesive” cements Bond strengths (Reality) Dentin Enamel EmbracePanavia F 2.0 7.6 11.5Bistite II 14.7 12.7Multilink 15.1 16.4 “Total-etch” 30.3 25.4 Relyx
  85. 85. Disadvantages ofAssisted “Self-adhesive” cements Involves an adhesive step Bonds not as strong as “Total-etch”
  86. 86. Can we “etch “with phosphoric acid with self-etch cements?Enamel Bonds Total-etch Self-etch Panavia F 2.0 18.3 11.8 Unicem 16.6 8.5 Multilink 21.2 16.4 BisCem 15.0 13.8 Decreased bond strengths to dentin
  87. 87. When do I use what?Non-core supported ceramic: “Total etch”Core-supported Ceramic Minimal retention and resistance form? “Total-etch” with dual cure resin cement Adequate retention and resistance? “self-adhesive” resin cements
  88. 88. Hornbrook 2009 Updates – Full Day EventsTopics include:•2009 Materials Update•My top 10 failures and how YOU can avoid them!•Treatment Planning the Full Mouth Rehabilitation•Winning Case Presentation Techniques for a ToughEconomy•Prepless Veneers: Necessary Addition to YourRestorative Arsenal•And much more! November 6th – Albuquerque, NM November 13th – Boston, MA at Tufts University
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