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DENTAL CEMENTS
Dr. Md. A. K. Nawaz
MDS II
Department Of Conservative Dentistry And
Endodontics
CONTENTS
• Glossary
• Introduction
• History
• Classification
• Ideal requirements of Dental Cements
• Phosphate Based Cements
• Zinc Phosphate Cement
• Phenolate Based Cements
• Zinc oxide Eugenol cement
• Calcium Hydroxide Cement
• Polycarboxylate Based Cements
• Zinc Polycarboxylate
• Glass Ionomer cements
• Polymer Based Cements
• Acrylic resin cement
• Adhesive resin cement
• Dimethacrylate cement
• Agents for pulp protection
• Cavity varnish
• Cavity liner
• Cavity base
• Conclusion
• References
GLOSSARY
ACID – BASE REACTION
Chemical reaction between a compound with replaceable hydrogen ions (acid) and a
substance with replaceable hydroxide ions (base) that yields salt and water.
BASE
A material that is used to protect the pulp in a prepared cavity by providing thermal
insulation.
FILM THICKNESS
According to ADA/ANSI Sp. No. 96, it is the thickness in micrometers of set cement
10minutes after a load of 150N has applied by a flat plate against another flat surface.
LUTING AGENT
A viscous cement-like material that fills the gap between bonded materials
SETTING TIME
The time elapsed from the start of mixing to the time at which the setting reaction
essentially stops as measured by reaching a desired hardness or consistency.
WORKING TIME
The elapsed time from the start of mixing to the time at which the consistency of a
material is no longer suitable for its intended use or a rapid rise in viscosity occurs.
INTRODUCTION
• Dental cements have been in use in dentistry for a very long time.
• They serve several purposes such as retaining restorations and prosthesis in the
mouth.
• Also restorative, endodontic, orthodontic, periodontic as well as surgical procedures.
• Last 2 decades have seen a variety of changes in the dental cement composition
and also introduction of newer advanced biocompatible materials.
• Definition:
• A substance that hardens from a viscous state to a solid state to join 2 surfaces.
• In dentistry, A cement acts as a base, liner, filling material or adhesive to bind
devices and prosthesis to tooth surfaces or to each other.
HISTORY
• First used dental cement- silicate cement
• 1871- Silicate cements (Fletcher)
• 1879- Zinc phosphate cements (Otto Hoffman)
• 1920- Calcium hydroxide (Hermann)
• 1942- Zinc oxide eugenol (Chrisholm)
• 1947- Methyl methacrylate resins
• 1960- Composites
• 1972- Glass Ionomers (Wilson & Kent)
• Based on the INGREDIENTS
WATER BASED
Glass & Resin Modified Glass Ionomer
Zinc Polycarboxylate
Zinc Phosphate
OIL BASED
Zinc oxide eugenol
Non-eugenol Zinc oxide
RESIN BASED
Composite and Adhesive Resins
Compomer
Classification
• According to O’Brien (by Matrix type):
PHOSPHATE
Zinc Phosphate
Zinc Silico phosphate
PHENOLATE
Zinc oxide eugenol
Calcium Hydroxide Salicylate
POLYCARBOXYLATE
Zinc Polycarboxylate
Glass Ionomer
RESIN
Polymethy Methacrylate
Dimethyl Methacrylate
Adhesive
RESIN MODIFIED GLASS IONOMER
Hybrid Ionomer
• According to Phillip’s:
Cement Primary Use Secondary Use
ZnPO4 • Luting agent for restoration
and orthodontic bands
• Intermediate restorations
• Thermal insulating bases
• Root canal restorations
ZnPO4 With Silver & Copper
Salts
• Intermediate restorations
Copper Phosphate • Temporary and intermediate
restorations
ZOE • Temporary and intermediate
restorations
• Luting agent
• Thermal insulating bases
• Pulp capping agents
• Root canal restorations
• Periodontic bandage
Poly Carboxylate • Luting agent
• Thermal insulating bases
• Luting agent for orthodontic
bands
• Intermediate restorations
Cement Primary Use Secondary Use
Silicate • Anterior fillings
Silicophosphates • Luting agent for restoration • Intermediate restorations
• Luting agent for orthodontic
appliances
GIC • Coating for eroded areas
• Luting agent for restoration
• Pit &fissure sealants
• Anterior restorations
• Thermal insulating bases
Resin • Luting agent • Temporary restorations
Ca(OH) 2 • Thermal insulating bases
• Pulp capping agents
IDEAL REQUIREMENTS
• Non-toxic, Non-irritant to pulp and tissues
• Insoluble
• Mechanical properties
• Adhesion to enamel and dentin
• Bacteriostatic
• Obtundant effect on pulp
• Thermal, chemical and electrical insulation
• Optical properties
CHARACTERISTIC PROPERTIESOF DENTAL
CEMENTS
FILM THICKNESS & CONSISTENCY
Height of space between two surfaces separated by cement
Eg:distance between tooth surface and cemented crown
• Determines the adaptability and retention of restoration
• Consistency of the cement should be thick and plastic enough for ease of handling and
placement into the cavity
• Heavier the consistency
 Greater the film thickness
 Less complete seating of restoration
• Maximum allowable film thickness
• For luting application : 20-25 µm
• For restorative application -temporary/final cementation : 40 µm
• Ultimate film thickness depends up on the
• Particle size of the powder
• Concentration of the powder in liquid
• Viscosity of liquid
• Consistency of cement
• Amount of force
VISCOCITY
Resistance of a liquid to flow
• It is a measure of consistency
• Factors affecting viscosity
• Increase in temperature and time - increase the viscosity of certain cements
SETTINGTIME
The elapsed time from the start of mixing to the point at which the mixture reaches a
desired hardness or consistency
Net setting time:
Time elapsed between the end of the mixing and the time of setting
Working time:
Elapsed time from the start of mixing to the point at which the consistency of the
material is no longer suitable for its intended use
STRENGTH
• ANSI /ADA specification recomends that the standard luting consistency of dental cement
must exhibit a minimum 24 hr compressive strength of 70 Mpa
SOLUBILITY
• Solubility in oral fluids & water
• Water based cements are more soluble than resin or oil-based cements
• Decrease in P:L ratio : higher solubility and disintegration rate
• ADA - 0.2Wt%
• Maximum permissible rates of dissolution
• GIC : 0.1 wt%
• Zinc Phosphate : 0.2 wt%
• Zinc Polycarboxylate : 0.3 wt%
REMAINING DENTINTHICKNESS
• Type of material to be used depends upon the minimum thickness
of the dentin left between the pulp floor and the dental pulp –
Remaining Dentin Thickness (RDT)
• RDT ≥ 2mm :
• Cavity Liner only to be given on all internal
surfaces (for metallic restorations)
• No liners or base for GIC or Composite
• RDT < 2mm :
• Base must be given on the pulpal and axial floor
(0.5 – 0.75mm)
• RDT < 1mm :
• Cavity Liner is given on all internal surfaces, over which
a Base is given.
LUTING MECHANISM
• By Schillinburg
• Non-Adhesive:
• Cement fills the restoration-tooth gap and holds by engaging in small surface
irregularities
• Micromechanical Bonding:
• Surface irregularities are enhanced by air abrasion or acid etching
• Improves the frictional retention
• Molecular Bonding:
• Chemical bond formation between cement and the tooth structure
ZINC PHOSPHATE CEMENT
• Introduced by Dr. Otto Hoffman during the 1800s
• One of the oldest cement
• Acts as the gold standard by which newer materials are compared.
APPLICATION
• Luting of restorations
• Luting of orthodontic bands
• High strength bases
COMPOSITION
POWDER % Function
ZnO 90.2% Principle ingredient
MgO 8.2% Reduce temperature of calcination process
SiO2 1.4% Improves the working characteristics
Bi2O3 0.1% Smoothness of mix &lengthen working time
Misc- BaO, Ba2SO4 & CaO 0.1%
LIQUID
H3 PO4 38.2% Reacts with ZnO
Al 2.5% Essential for cement forming reaction
Zn 7.1% Moderator for reaction between powder& liquid, allows
adequate working time
H20 36% Controls the rate of reation
TYPES
• Type I – Fine Grained : (Film Thickness less than 25µm)
• Luting permanent metallic restorations
• Cementation of orthodontic bands
• Type II – Medium Grained : (Film Thickness of 40µm)
• High strength thermal insulating base
3ZnO + 2H3PO4 + H2O Zn3(PO4)2.4H20
SETTING REACTION
• Phosphoric acid attacks the surface of the particles
• Releases zinc ions into the liquid
• Aluminium forms complexes with phosphoric acid, reacts
with zinc forming zinc aluminophosphate gel.
• Exothermic reaction.
• The final set cement is a cored structure consisting primarily of unreacted zinc oxide
particles embedded in a cohesive amorphous matrix of zinc aluminophosphate.
MANIPULATION
• P:L ratio of 1.4g : 0.5ml
• Amount of powder that can be incorporated into a given quantity of the liquid greatly
determines the properties of the mixed mass of the cement.
• This is because increase in P:L ratio generally provides more desirable properties.
• Powder is dispensed onto the glass slab
• Divided into 4 – 6 increments.
• Powder is incrementally incorporated into the liquid
• Spatulated over a large area to dissipate heat produced during the
reaction.
• Powder quantity being minimal, heat generated is less
• Helps to achieve slow neutralization of the liquid and better
control of setting reaction
• During middle of mixing, larger portions are added to further
saturate the liquid.
• Finally,smaller increments are added to get the desired consistency.
• Each increment is spatulated for 15-20secs.
• Total mixing time is 60 – 90 secs.
Frozen Glass slab Technique:
• To prolong working time and shorten setting time.
• Glass slab cooled at 6°C or – 10°C.
• 50 – 75% more powder incorporation.
• Working time is increased by 4 – 11 mins
• Setting time shortened by 20 – 40%
Mixing time 1.5 – 2mins (Phillips)
Working time 5mins (Phillips)
Setting time 5-9mins (Craig)
5-14mins (O’Brien)
Film thickness 20µm
MECHANICAL PROPERTIES
Compressive Strength 104 Mpa
Tensile Strength 5.5 Mpa
Elastic Modulus 13.5 Gpa
Solubility in water 0.06 wt%
Thermal conductivity 0.0028°C/cm
FACTORS AFFECTING SETTING TIME
• P:L ratio
• Reducing the P:L ratio increases the working time and setting time
• Low initial pH which will impair the mechanical properties
• Smaller increments mixed for first few increments
• Prolonging the spatulation time
• Temperature of the mixing slab
BIOLOGIC PROPERTIES
• Freshly mixed ZnPO4 - highly acidic pH - pulpal irritation
• Very thin mixes must be avoided as it can be highly acidic.
• Pulp protection : High P:L ration must be used, Calcium hydroxide or cavity varnish.
• ADHESION : By mechanical interlocking of the set cement with cavity surface roughness
• Acts as a good thermal insulator.
MODIFIED ZINC PHOSPHATE CEMENT
SILICOPHOSPHATE CEMENTS (ADA Sp. No. 96)
• Presence of silicate glass: translucency, improved strength, fluoride release.
APPLICATIONS
• Type I : Cementation of fixed restorations
• Type II : Provisional restorative material
• Type III : Dual purpose material
COMPOSITION
POWDER % Function
ZnO 10 -20 Principle ingredient
Silicate glass
Fluoride 12 – 25
Mercury / Silver Compounds Germicidal
LIQUID
Orthophosphoric acid Reacts with ZnO
Al salts 2 – 5
Water 45
PROPERTIES
BIOLOGIC EFFECT
• Prolonged low pH (4-5)
• Pulpal protection necessary
• Anticariogenic – fluoride release
Working time 4 mins
Setting time 5 – 7 mins
Compressive Strength 140 - 170 Mpa
Tensile Strength 7 Mpa
Solubility 1 wt%
Toughness/Abrasion resistane Higher than phosphate cements
ADVANTAGES DISADVANTAGES
Better strength, toughness, abrasion
resistance, fluoride release,
translucency
Total acidity greater than zinc
phosphate
Better bonding than zinc phosphate High solubility
ZINC OXIDE EUGENOL (ADA SP. NO. 30)
• Introduced by Chrisholm in 1873
• Commonly used for luting and intermediate restorations
• Obtundant property on exposed dentin
APPLICATION
• Longterm and short-term luting agents
• Temporary and intermediate restorations
• Root canal sealers
• Surgical packs
TYPES (ADA Specification No. 30)
• Type I
• Type II
: Temporary restorations
: Permanent cementation of restorations
• Type III : Temporary restoration, thermal insulating bases
• Type IV : Cavity Liner
Dispensed As:
• Two pastes
• Powder and liquid
COMPOSITION
POWDER % Function
ZnO 69 Principal component
White rosin 29.3 Reduce brittleness of the cement
Zinc stearate 1 Accelerator, plasticizer
Zinc acetate 0.7 Improves strength of the cement
Silica Filler
LIQUID
Eugenol / oil of cloves 85
Olive oil 15 Plasticizer
SETTING REACTION
• Hydrolysis of the ZnO
ZnO + H2O Zn(OH)2
Zn(OH)2 + 2HE ZnE2 + 2H20
• Zinc hydroxide reacts with acid eugenol forming zinc eugenolate which crystalizes and
strengthens the cement
• Set cement also contains free zinc oxide embedded in a matrix of zinc eugenolate
• Reaction is reversible, zinc eugenolate can easily be hydrolysed by moisture in the oral
cavity to eugenol and zinc hydroxide
MANIPULATION
• P:L = 3:1 / 4:1 (maximum strength)
• Powder and liquid are dispensed onto the glass slab.
• Zinc oxide is incorporated into the liquid
• Prolonged vigorous spatulation in circular motion is
required with a stiff bladed stainless steel spatula.
• Larger increments are incorporated first and then smaller
increments until desired consistency is obtained.
• More powder is added to the mix, more stronger is the
cement and more viscous the mixed cement.
PROPERTIES
Base / Filling
material
Temporary
cement
Permanent
cement
Cavity liner
Film Thickness (µm) 40 25
Setting Time (mins) 2 – 10 4 – 10 4 – 10 4 – 10
Solubility (wt%) 2.5 1.5
Compressive strength (Mpa) 25 35 35 5.5
Tensile strength (Mpa) 1 – 2 1 – 2 1 – 2 1 – 2
Thermal diffusivity 0.38 mm2/s
Linear COTE 35 x 10-6/°C
BIOLOGIC EFFECTS
• Bacteriostatic
• Obtundant property
• pH (6.6 – 8) : mild pulpal response
• Volumetric shrinkage : 0.9%
• When in direct contact with connective tissues, it is an irritant
• Reparative dentin formation in exposed pulp is variable
ADVANTAGES DISADVANTAGES
Obtundant effect on pulpal tissues Low strength and low abrasion
resistance
Good sealing ability Microleakage
Resistance to marginal penetration Disintegration in oral fluids
Good thermal insulation Less anticariogenic
Solubility is highest among all cements
CALCIUM HYDROXIDE
• Hermann – 1920
• Useful water setting cement which has osteoconductive and osteoinductive property
• As a pulp capping agent facilitates formation of reparative dentin – alkaline pH ,
antibacterial and protein lyzing property.
TYPES:
• Non setting (pH : 11 – 13) – intracanal medicament
• Setting (pH : 9 – 10) – cavity liner
APPLICATION
• Liners in deep cavity preparations
• Intracanal medicaments
• Direct and indirect pulp capping
• Apexification procedures
COMPOSITION
• 2 Pastes – Base and Catalyst
BASE
Calcium tungstate / Barium sulphate Radio-opacifier
Tribasic calcium phosphate
Zinc oxide
Glycol salicylate
SETTING REACTION
• Calcium hydroxide reacts with the salicylate forming a chelate, amorphous calcium
disalicylate.
• Hydroxyl ions from the cement neutralize the acids produced from the clast cells and create
an optimum pH for pyrophosphatase activity necessary for mineralization.
CATALYST
Calcium hydroxide
ZnO
Zn Stearate
Ethylene Toluene
MANIPULATION
• Equal lengths of the 2 pastes are mixed to a uniform color
PROPERTIES
Working time 3 – 5 mins (depends on availability of moisture
1 – 2 mins (rapid)
Compressive Strength At 7 mins : 6MPa
At 1 hr : 10MPa
At 24hrs : 14-20MPa
Tensile Strength At 7 mins : 1.5MPa
At 1 hr : 1.5MPa
At 24hrs : 1.7-2MPa
• Solubility in 50% phosphoric acid during etching procedures is significant.
• Subject to Hydrolytic Breakdown : marginal leakage and finally complete dissolution of the
lining occurs
BIOLOGIC EFFECTS
• Strong Antibacterial Action
• Ionic dissociation of calcium hydroxide into calcium ions and hydroxyl ions.
(54.11% and 45.89% respectively)
• Hydroxyl ions induces chemical injury on the organic components of the
cytoplasmic membrane of the bacteria, causing destruction of phospholipids or
unsaturated fatty acids.
phoshphatase which is responsible for
• Dentin Bridge Formation (Pulp Capping)
• Activates enzymes such as alkaline
mineralization
• Free calcium hydroxide helps in remineralization of carious dentin
ADVANTAGES DISADVANTAGES
Easy manipulation Low strength even when fully set
Rapidly harden in thin layers Exhibit plastic deformation
Good sealing ability Dissolve under acidic conditions
Beneficial effects on carious dentin and
exposed pulp
LIGHT ACTIVATEDCALCIUM HYDROXIDE
• Recently introduced cement
COMPOSITION
• They have longer working time
Calcium Hydroxide
Barium sulphate Radio-opacifier
Urethane dimethacrylate
HEMA
Activators – camphorquinone
ADVANTAGES
Less brittle than conventional 2 paste
system
Improved strength
No solubility in acids
Minimal solubility in water
Longer working time
DYCAL
• Introduced in 1979
• As a liner/pulp capping agent in deep cavities
• Radio-opaque calcium hydroxide which is self setting
ADVANTAGES DISADVANTAGES
High early strength
Lower water solubility
Excellent handling characteristics
SILICATE CEMENTS (ADA SP
. NO.
96)
• Fletcher in 1871
• Oldest direct tooth colored materials
• Steenbock later introduced an improved version of the cement
COMPOSITION
POWDER LIQUID
Silicon Dioxide 35 – 50% Phosphoric acid
Sodium fluoride Sodium & Aluminium phosphate
Calcium fluoride
Aluminium fluoride
Aluminium trioxide
Sodium fluoride
SETTING REACTION
• Acid – Base Reaction
• Powder particles are attacked by acid releasing Calcium, aluminium and fluoride ions.
• These ions precipitate as phosphates which form continuous cement matrix along with and
forms a silica gel.
• Fluoride ions donot take part in this reaction. Present as free ions.
• Most of the powder particles are not dissolved, only the surfaces are dissolved.
• Finally the set cement contains a phosphate matrix containing unreacted powder particles
surrounded by acid gel and fluoride ions.
PROPERTIES
• Anticariogenic : large amounts of fluoride
• Soluble in saliva. High in acidic conditions
• Coefficient of thermal expansion: close to tooth structure : Microleakage is minimal
• Good optical properties
• pH remains low as 3 for few days : pulpal irritation
• pH remains below 7 even after a month: severe pulpal irritant
• Adhesion : mechanical bonding to tooth structure
ADVANTAGES DISADVANTAGES
Translucency High pulpal irritant
Anticariogenic Highly soluble
POL
YCARBOXYLATE CEMENT (ADA SP
. NO. 96)
• Dennis Smith : 1968
• First cement system with adhesive bond to tooth structure
• Also known as polyacrylate cement
APPLICATION
• Luting alloy restorations
• Thermal insulating bases
• Cementing orthodontic bands
• Cementing SS crown in pediatric dentistry
COMPOSITION
POWDER %
ZnO
SnO / MgO 1 – 5
Aluminium oxide 10 – 40
Stannous Fluoride : Modified setting time
LIQUID
40% Aqueous solution of Polyacrylic Acid
SETTING REACTION
• Powder particles are attacked by the acid releasing Zn, Mg, Sn ions.
• Ions bind to the polymer chain via the carboxyl groups.
• Ions also react with carboxyl group of adjacent polyacid chains to form cross linked salts.
Bonding to tooth
• Polyacrylic acid reacts with Calcium ions via the carboxyl groups on the surface of enamel
and dentin.
MANIPULATION
• P:L = 1.5g : 1ml
• Mixing should be done on a surface that do not absorb liquid.
• Most of the powder should be incorporated into the liquid in one large increment.
• Mixed over a small area with a stiff spatula
• More powder is then added to obtain the required consistency
• Mix should be used while it is still in the glossy state.
• Mixed rapidly in 30 – 40 secs
• Working time : 2.5 – 3.5 mins
• Setting time : 6-9mins (at 37°C)
Methods to Increase the working time
• Cooling glass slab :
• Thickening of the liquid
• Difficulty in mixing
• Powder refridgerated before mixing
• Reaction occurs on cool surface, cool temperature retards the reaction without
thickening of the liquid.
PROPERTIES
• Solubility in water is low
• In organic acid with pH < 4.5 : increased solubility
• Reduced P:L ratio : increases solubility in oral cavity
Film Thickness 25 µm
Compressive Strength 55 - 85 Mpa
Tensile Strength 8 - 12 Mpa
Modulus of elasticity 6 Gpa
Bond strength to enamel 3.4 – 4.7 Mpa
Bond strength to dentin 2.1 Mpa
Thermal diffusivity 0.223mm2/sec
BIOLOGIC EFFECTS
• Good biocompatibility
• Low intrinsic toxicity
• Rapid rise in pH towards neutrality
• Fluoride release
ADVANTAGES DISADVANTAGES
Low irritation Lower compressive strength
Chemical bond to tooth structure and
alloys
Greater viscoelasticity
Easy manipulation Need for clean surfaces for adhesion
Adequate strength Short working time
Low solubility
Adequate film thickness
Anticariogenic
• Glass polyalkenoate cement is the proper designation for specialized
glass powders that react with polyacrylic acid. However, glass ionomer,
glass-ionomer cement, and GIC are recognized as acceptable names
within the dental profession
• The glass-ionomer cements are an improvement over the predecessor
silicate cements because they include the bonding mechanism found in
the zinc carboxylate cement with glass powder.
• The result is a superior and versatile material that is adherent,
translucent, and fluoride releasing.
GLASS IONOMER CEMENTS(GIC)
GICs have been used for
(1) the esthetic restoration of anterior teeth (e.g., class III
and V sites),
(2) adhesive cements for fixed prosthe-ses and orthodontic
appliances,
(3) intermediate restorations,
(4) pit and fissure sealants,
(5) cavity liners and bases, and
(6) core buildup materials
COMPOSITION
• A nonabsorbent paper pad or a cool, dry glass slab may be
used for mixing GIC.
• The powder and liquid should be dispensed just before mixing
is begun; otherwise, evaporation of water increases the
acidity of the liquid. The powder should be rapidly spatulated
into the liquid in less than 45 seconds, or as prescribed in the
instructions for use
• Normally, one-half of the powder is mixed into the liquid for 5
to 15 seconds; then the remaining powder is quickly added
and mixed by folding the cement on itself until a uniform and
glossy appearance is observed
ACRYLIC RESINCEMENT
APPLICATION
• Cementation of restorations, facings and crowns
COMPOSITION
POWDER
MMA polymer or Copolymer
Benzyl Peroxide
Mineral Filler
Pigments
LIQUID
MMA monomer
Amine Accelerators
MANIPULATION
• Liquid is added to powder with minimal spatulation to avoid incorporation of air.
• Short working time – mix must be used immediately
• Excess material is removed only after final set.
• When cement is hard, and not when rubbery since it creates marginal deficiencies.
PROPERTIES
• Stronger and less soluble
• Low rigidity and visco-elastic properties
• No effective bond to the tooth structure in the presence of moisture
BIOLOGIC EFFECTS
• Marked pulpal response
ADVANTAGES DISADVANTAGES
High strength Marked pulpal irritation
High toughness Short working time
Low solubility Difficulty in removal of the excess cement
ADHESIVE RESINCEMENT
• Formulated by adding the following to MMA monomer:
• 4 methacryloxy ethyl trimellitate anhydride (4-META)
• Tributyl boron initiator (helps in adhesion)
APPLICATION
• Luting FPD and base metal
• Bonding amalgam to dentin and composite
PROPERTIES
• (similar to acrylic resin)
• Stronger and less soluble
• Low rigidity and visco-elastic properties
• No effective bond to the tooth structure in the presence of moisture
• Moderate strength and high deformation under a load.
PROPERTIES
• Marked pulpal response
99
PURPOSE OF A CAVITY LINER / VARNISH
• Serve as a physical barrier to ingress of bacteria/ bacterial byproducts.
• To provide therapeutic effect such as antibacterial, anticariogenic or pulpal anodyne effect.
• Provide barrier for protection of pulp from residual reactants
diffusing out of a restoration.
• Prevent oral fluids that may penetrate leaky restorations from
reaching the pulp through the dentin
84
CAVITYVARNISH
• A solution of one or more resins which when applied to the cavity walls, evaporates,
leaving a thin resin film that serves as a barrier between the restoration and the dentinal
tubules.
APPLICATION
• Prevents post-op sensitivity from galvanic shock
• Minimize penetration of acid from zinc phosphate cements
• Prevent diffusion of corrosion products from dental amalgam into dentin
CONTRAINDICATION
• Not to be used with Glass Ionomer Cement or Resin composites
85
COMPOSITION
86
MANIPULATION
• Applied by means of small cotton pellets / brush / applicator
• 2 – 3 layers – sufficient protection
• Volatile solvents evaporate quickly after application, leaving a thin resin film
Solid Copal Resin, Rosin Or Synthetic Resin
Solvent 90% Ether, Acetone Or Alcohol
Medicinal Agent Chlorbutanol, Thymol, Eugenol
PROPERTIES
87
Film thickness 1 – 4 µm
Tensile strength < 1 Mpa
Low solubility in water
CAVITY LINER
• Suspensions of calcium hydroxide in a volatile solvent.
• Used like a cavity varnish to provide barrier against the passage of irritants
from the cements and other restorative materials.
COMPOSITION
• Suspension of calcium hydroxide in an organic liquid such as methyl ethyl
ketone or ethyl alcohol.
88
PROPERTIES
89
• No significant thermal insulation
• Soluble : should not be applied to margins of restorations
• Fluoride compounds are added to newer compounds to prevent secondary caries
Film thickness 1 – 4 µm
Tensile strength < 1 Mpa
MANIPULATION
• (Similar to varnishes)
• Applied by means of small cotton pellets / brush / applicator
• 2 – 3 layers – sufficient protection
• Volatile solvents evaporate quickly after application, leaving a thin resin film
90
Other Liners
• Type III Glass Ionomer Cement
• Type IV Zinc Oxide Eugenol
BASES
91
• Material that is used to protect the pulp in a prepared cavity by providing thermal
insulation
• Ie these are those cements commonly used in thicker dimensions beneath permanent
restorations to provide for mechanical, chemical and thermal protection to the pulp.
• Eg:
• Zinc Phosphate
• Zinc Oxide Eugenol
• Calcium Hydroxide
• Zinc Polycarboxylate
• Glass Ionomer
INDICATIONS OF A CAVITY BASE
• To protect the pulp against thermal injury, galvanic shock and chemical irritation. (Zinc
phosphate under amalgam restoration)
• To withstand the forces of condensation of the restorative material and act as shock
absorbers. (Zinc phosphate under amalgam restoration)
• To substitute dentin in deep cavities. (all high strength bases)
• To serve as intermediate bonding material between the tooth
and composite restoration. (GIC in sandwich technique)
92
CLASSIFICATION
93
• Low strength bases
• Zinc oxide Eugenol, calcium hydroxides
• Calcium hydroxide as a sub-base
• High strength bases
• GIC, reinforced ZOE, Zinc phosphate, Zinc polycarboxylate
• Used under direct and indirect metallic restorations
• Only some bases are indicated under composite resins (GIC)
CLINICAL CONSIDERATIONS
94
Clinician must observe certain general guidelines for placement of bases:
• Base should be 0.5 – 0.75mm thick.
• Very thick bases compromise the bulk of the restoration
• Increase the potential for fracture of the restoration
• It is not recommended to remove sound tooth structure inorder to provide space
for a base
• Bases are applied only on internal walls of the cavity preparation to prevent
dissolution by saliva
CONCLUSION
95
• No single type of cement satisfies all of the ideal requirements or is best suited for
all indications in dentistry
• Each situation must be evaluated based on the environmental, mechanical and
biological factors and finally decide on which material to be used in each case.
REFERENCES
96
• Phillip’s Science of Dental Materials : Anusavice ( 12th Edition )
• Phillip’s Science of Dental Materials : Anusavice ( 10th Edition )
• Craig’s Restorative Dental Materials ( 13th Edition )
• Craig’s Restorative Dental Materials ( 12th Edition )
• Dental Materials and their Selection : William J O’Brien ( 4th Edition )
• Materials Used in Dentistry : S.Mahalexmi ( 1st Edition )
Dental Cements - Dr. Nithin Mathew

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Dental Cements in conservative dentistry

  • 1. DENTAL CEMENTS Dr. Md. A. K. Nawaz MDS II Department Of Conservative Dentistry And Endodontics
  • 2. CONTENTS • Glossary • Introduction • History • Classification • Ideal requirements of Dental Cements • Phosphate Based Cements • Zinc Phosphate Cement • Phenolate Based Cements • Zinc oxide Eugenol cement • Calcium Hydroxide Cement • Polycarboxylate Based Cements • Zinc Polycarboxylate • Glass Ionomer cements
  • 3. • Polymer Based Cements • Acrylic resin cement • Adhesive resin cement • Dimethacrylate cement • Agents for pulp protection • Cavity varnish • Cavity liner • Cavity base • Conclusion • References
  • 4. GLOSSARY ACID – BASE REACTION Chemical reaction between a compound with replaceable hydrogen ions (acid) and a substance with replaceable hydroxide ions (base) that yields salt and water. BASE A material that is used to protect the pulp in a prepared cavity by providing thermal insulation. FILM THICKNESS According to ADA/ANSI Sp. No. 96, it is the thickness in micrometers of set cement 10minutes after a load of 150N has applied by a flat plate against another flat surface.
  • 5. LUTING AGENT A viscous cement-like material that fills the gap between bonded materials SETTING TIME The time elapsed from the start of mixing to the time at which the setting reaction essentially stops as measured by reaching a desired hardness or consistency. WORKING TIME The elapsed time from the start of mixing to the time at which the consistency of a material is no longer suitable for its intended use or a rapid rise in viscosity occurs.
  • 6. INTRODUCTION • Dental cements have been in use in dentistry for a very long time. • They serve several purposes such as retaining restorations and prosthesis in the mouth. • Also restorative, endodontic, orthodontic, periodontic as well as surgical procedures. • Last 2 decades have seen a variety of changes in the dental cement composition and also introduction of newer advanced biocompatible materials.
  • 7. • Definition: • A substance that hardens from a viscous state to a solid state to join 2 surfaces. • In dentistry, A cement acts as a base, liner, filling material or adhesive to bind devices and prosthesis to tooth surfaces or to each other.
  • 8. HISTORY • First used dental cement- silicate cement • 1871- Silicate cements (Fletcher) • 1879- Zinc phosphate cements (Otto Hoffman) • 1920- Calcium hydroxide (Hermann) • 1942- Zinc oxide eugenol (Chrisholm) • 1947- Methyl methacrylate resins • 1960- Composites • 1972- Glass Ionomers (Wilson & Kent)
  • 9. • Based on the INGREDIENTS WATER BASED Glass & Resin Modified Glass Ionomer Zinc Polycarboxylate Zinc Phosphate OIL BASED Zinc oxide eugenol Non-eugenol Zinc oxide RESIN BASED Composite and Adhesive Resins Compomer Classification
  • 10. • According to O’Brien (by Matrix type): PHOSPHATE Zinc Phosphate Zinc Silico phosphate PHENOLATE Zinc oxide eugenol Calcium Hydroxide Salicylate POLYCARBOXYLATE Zinc Polycarboxylate Glass Ionomer RESIN Polymethy Methacrylate Dimethyl Methacrylate Adhesive RESIN MODIFIED GLASS IONOMER Hybrid Ionomer
  • 11. • According to Phillip’s: Cement Primary Use Secondary Use ZnPO4 • Luting agent for restoration and orthodontic bands • Intermediate restorations • Thermal insulating bases • Root canal restorations ZnPO4 With Silver & Copper Salts • Intermediate restorations Copper Phosphate • Temporary and intermediate restorations ZOE • Temporary and intermediate restorations • Luting agent • Thermal insulating bases • Pulp capping agents • Root canal restorations • Periodontic bandage Poly Carboxylate • Luting agent • Thermal insulating bases • Luting agent for orthodontic bands • Intermediate restorations
  • 12. Cement Primary Use Secondary Use Silicate • Anterior fillings Silicophosphates • Luting agent for restoration • Intermediate restorations • Luting agent for orthodontic appliances GIC • Coating for eroded areas • Luting agent for restoration • Pit &fissure sealants • Anterior restorations • Thermal insulating bases Resin • Luting agent • Temporary restorations Ca(OH) 2 • Thermal insulating bases • Pulp capping agents
  • 13. IDEAL REQUIREMENTS • Non-toxic, Non-irritant to pulp and tissues • Insoluble • Mechanical properties • Adhesion to enamel and dentin • Bacteriostatic • Obtundant effect on pulp • Thermal, chemical and electrical insulation • Optical properties
  • 14. CHARACTERISTIC PROPERTIESOF DENTAL CEMENTS FILM THICKNESS & CONSISTENCY Height of space between two surfaces separated by cement Eg:distance between tooth surface and cemented crown • Determines the adaptability and retention of restoration • Consistency of the cement should be thick and plastic enough for ease of handling and placement into the cavity • Heavier the consistency  Greater the film thickness  Less complete seating of restoration
  • 15. • Maximum allowable film thickness • For luting application : 20-25 µm • For restorative application -temporary/final cementation : 40 µm • Ultimate film thickness depends up on the • Particle size of the powder • Concentration of the powder in liquid • Viscosity of liquid • Consistency of cement • Amount of force
  • 16. VISCOCITY Resistance of a liquid to flow • It is a measure of consistency • Factors affecting viscosity • Increase in temperature and time - increase the viscosity of certain cements
  • 17. SETTINGTIME The elapsed time from the start of mixing to the point at which the mixture reaches a desired hardness or consistency Net setting time: Time elapsed between the end of the mixing and the time of setting Working time: Elapsed time from the start of mixing to the point at which the consistency of the material is no longer suitable for its intended use
  • 18. STRENGTH • ANSI /ADA specification recomends that the standard luting consistency of dental cement must exhibit a minimum 24 hr compressive strength of 70 Mpa SOLUBILITY • Solubility in oral fluids & water • Water based cements are more soluble than resin or oil-based cements • Decrease in P:L ratio : higher solubility and disintegration rate • ADA - 0.2Wt% • Maximum permissible rates of dissolution • GIC : 0.1 wt% • Zinc Phosphate : 0.2 wt% • Zinc Polycarboxylate : 0.3 wt%
  • 19. REMAINING DENTINTHICKNESS • Type of material to be used depends upon the minimum thickness of the dentin left between the pulp floor and the dental pulp – Remaining Dentin Thickness (RDT) • RDT ≥ 2mm : • Cavity Liner only to be given on all internal surfaces (for metallic restorations) • No liners or base for GIC or Composite
  • 20. • RDT < 2mm : • Base must be given on the pulpal and axial floor (0.5 – 0.75mm) • RDT < 1mm : • Cavity Liner is given on all internal surfaces, over which a Base is given.
  • 21. LUTING MECHANISM • By Schillinburg • Non-Adhesive: • Cement fills the restoration-tooth gap and holds by engaging in small surface irregularities • Micromechanical Bonding: • Surface irregularities are enhanced by air abrasion or acid etching • Improves the frictional retention • Molecular Bonding: • Chemical bond formation between cement and the tooth structure
  • 22.
  • 23. ZINC PHOSPHATE CEMENT • Introduced by Dr. Otto Hoffman during the 1800s • One of the oldest cement • Acts as the gold standard by which newer materials are compared. APPLICATION • Luting of restorations • Luting of orthodontic bands • High strength bases
  • 24. COMPOSITION POWDER % Function ZnO 90.2% Principle ingredient MgO 8.2% Reduce temperature of calcination process SiO2 1.4% Improves the working characteristics Bi2O3 0.1% Smoothness of mix &lengthen working time Misc- BaO, Ba2SO4 & CaO 0.1% LIQUID H3 PO4 38.2% Reacts with ZnO Al 2.5% Essential for cement forming reaction Zn 7.1% Moderator for reaction between powder& liquid, allows adequate working time H20 36% Controls the rate of reation
  • 25. TYPES • Type I – Fine Grained : (Film Thickness less than 25µm) • Luting permanent metallic restorations • Cementation of orthodontic bands • Type II – Medium Grained : (Film Thickness of 40µm) • High strength thermal insulating base
  • 26. 3ZnO + 2H3PO4 + H2O Zn3(PO4)2.4H20 SETTING REACTION • Phosphoric acid attacks the surface of the particles • Releases zinc ions into the liquid • Aluminium forms complexes with phosphoric acid, reacts with zinc forming zinc aluminophosphate gel. • Exothermic reaction. • The final set cement is a cored structure consisting primarily of unreacted zinc oxide particles embedded in a cohesive amorphous matrix of zinc aluminophosphate.
  • 27. MANIPULATION • P:L ratio of 1.4g : 0.5ml • Amount of powder that can be incorporated into a given quantity of the liquid greatly determines the properties of the mixed mass of the cement. • This is because increase in P:L ratio generally provides more desirable properties. • Powder is dispensed onto the glass slab • Divided into 4 – 6 increments.
  • 28. • Powder is incrementally incorporated into the liquid • Spatulated over a large area to dissipate heat produced during the reaction. • Powder quantity being minimal, heat generated is less • Helps to achieve slow neutralization of the liquid and better control of setting reaction • During middle of mixing, larger portions are added to further saturate the liquid. • Finally,smaller increments are added to get the desired consistency. • Each increment is spatulated for 15-20secs. • Total mixing time is 60 – 90 secs.
  • 29. Frozen Glass slab Technique: • To prolong working time and shorten setting time. • Glass slab cooled at 6°C or – 10°C. • 50 – 75% more powder incorporation. • Working time is increased by 4 – 11 mins • Setting time shortened by 20 – 40% Mixing time 1.5 – 2mins (Phillips) Working time 5mins (Phillips) Setting time 5-9mins (Craig) 5-14mins (O’Brien) Film thickness 20µm
  • 30. MECHANICAL PROPERTIES Compressive Strength 104 Mpa Tensile Strength 5.5 Mpa Elastic Modulus 13.5 Gpa Solubility in water 0.06 wt% Thermal conductivity 0.0028°C/cm
  • 31. FACTORS AFFECTING SETTING TIME • P:L ratio • Reducing the P:L ratio increases the working time and setting time • Low initial pH which will impair the mechanical properties • Smaller increments mixed for first few increments • Prolonging the spatulation time • Temperature of the mixing slab
  • 32. BIOLOGIC PROPERTIES • Freshly mixed ZnPO4 - highly acidic pH - pulpal irritation • Very thin mixes must be avoided as it can be highly acidic. • Pulp protection : High P:L ration must be used, Calcium hydroxide or cavity varnish. • ADHESION : By mechanical interlocking of the set cement with cavity surface roughness • Acts as a good thermal insulator.
  • 33. MODIFIED ZINC PHOSPHATE CEMENT SILICOPHOSPHATE CEMENTS (ADA Sp. No. 96) • Presence of silicate glass: translucency, improved strength, fluoride release. APPLICATIONS • Type I : Cementation of fixed restorations • Type II : Provisional restorative material • Type III : Dual purpose material
  • 34. COMPOSITION POWDER % Function ZnO 10 -20 Principle ingredient Silicate glass Fluoride 12 – 25 Mercury / Silver Compounds Germicidal LIQUID Orthophosphoric acid Reacts with ZnO Al salts 2 – 5 Water 45
  • 35. PROPERTIES BIOLOGIC EFFECT • Prolonged low pH (4-5) • Pulpal protection necessary • Anticariogenic – fluoride release Working time 4 mins Setting time 5 – 7 mins Compressive Strength 140 - 170 Mpa Tensile Strength 7 Mpa Solubility 1 wt% Toughness/Abrasion resistane Higher than phosphate cements
  • 36. ADVANTAGES DISADVANTAGES Better strength, toughness, abrasion resistance, fluoride release, translucency Total acidity greater than zinc phosphate Better bonding than zinc phosphate High solubility
  • 37.
  • 38. ZINC OXIDE EUGENOL (ADA SP. NO. 30) • Introduced by Chrisholm in 1873 • Commonly used for luting and intermediate restorations • Obtundant property on exposed dentin APPLICATION • Longterm and short-term luting agents • Temporary and intermediate restorations • Root canal sealers • Surgical packs
  • 39. TYPES (ADA Specification No. 30) • Type I • Type II : Temporary restorations : Permanent cementation of restorations • Type III : Temporary restoration, thermal insulating bases • Type IV : Cavity Liner
  • 40. Dispensed As: • Two pastes • Powder and liquid COMPOSITION POWDER % Function ZnO 69 Principal component White rosin 29.3 Reduce brittleness of the cement Zinc stearate 1 Accelerator, plasticizer Zinc acetate 0.7 Improves strength of the cement Silica Filler LIQUID Eugenol / oil of cloves 85 Olive oil 15 Plasticizer
  • 41. SETTING REACTION • Hydrolysis of the ZnO ZnO + H2O Zn(OH)2 Zn(OH)2 + 2HE ZnE2 + 2H20 • Zinc hydroxide reacts with acid eugenol forming zinc eugenolate which crystalizes and strengthens the cement • Set cement also contains free zinc oxide embedded in a matrix of zinc eugenolate • Reaction is reversible, zinc eugenolate can easily be hydrolysed by moisture in the oral cavity to eugenol and zinc hydroxide
  • 42. MANIPULATION • P:L = 3:1 / 4:1 (maximum strength) • Powder and liquid are dispensed onto the glass slab. • Zinc oxide is incorporated into the liquid • Prolonged vigorous spatulation in circular motion is required with a stiff bladed stainless steel spatula. • Larger increments are incorporated first and then smaller increments until desired consistency is obtained. • More powder is added to the mix, more stronger is the cement and more viscous the mixed cement.
  • 43. PROPERTIES Base / Filling material Temporary cement Permanent cement Cavity liner Film Thickness (µm) 40 25 Setting Time (mins) 2 – 10 4 – 10 4 – 10 4 – 10 Solubility (wt%) 2.5 1.5 Compressive strength (Mpa) 25 35 35 5.5 Tensile strength (Mpa) 1 – 2 1 – 2 1 – 2 1 – 2 Thermal diffusivity 0.38 mm2/s Linear COTE 35 x 10-6/°C
  • 44. BIOLOGIC EFFECTS • Bacteriostatic • Obtundant property • pH (6.6 – 8) : mild pulpal response • Volumetric shrinkage : 0.9% • When in direct contact with connective tissues, it is an irritant • Reparative dentin formation in exposed pulp is variable
  • 45. ADVANTAGES DISADVANTAGES Obtundant effect on pulpal tissues Low strength and low abrasion resistance Good sealing ability Microleakage Resistance to marginal penetration Disintegration in oral fluids Good thermal insulation Less anticariogenic Solubility is highest among all cements
  • 46. CALCIUM HYDROXIDE • Hermann – 1920 • Useful water setting cement which has osteoconductive and osteoinductive property • As a pulp capping agent facilitates formation of reparative dentin – alkaline pH , antibacterial and protein lyzing property. TYPES: • Non setting (pH : 11 – 13) – intracanal medicament • Setting (pH : 9 – 10) – cavity liner
  • 47. APPLICATION • Liners in deep cavity preparations • Intracanal medicaments • Direct and indirect pulp capping • Apexification procedures COMPOSITION • 2 Pastes – Base and Catalyst BASE Calcium tungstate / Barium sulphate Radio-opacifier Tribasic calcium phosphate Zinc oxide Glycol salicylate
  • 48. SETTING REACTION • Calcium hydroxide reacts with the salicylate forming a chelate, amorphous calcium disalicylate. • Hydroxyl ions from the cement neutralize the acids produced from the clast cells and create an optimum pH for pyrophosphatase activity necessary for mineralization. CATALYST Calcium hydroxide ZnO Zn Stearate Ethylene Toluene
  • 49. MANIPULATION • Equal lengths of the 2 pastes are mixed to a uniform color PROPERTIES Working time 3 – 5 mins (depends on availability of moisture 1 – 2 mins (rapid) Compressive Strength At 7 mins : 6MPa At 1 hr : 10MPa At 24hrs : 14-20MPa Tensile Strength At 7 mins : 1.5MPa At 1 hr : 1.5MPa At 24hrs : 1.7-2MPa
  • 50. • Solubility in 50% phosphoric acid during etching procedures is significant. • Subject to Hydrolytic Breakdown : marginal leakage and finally complete dissolution of the lining occurs
  • 51. BIOLOGIC EFFECTS • Strong Antibacterial Action • Ionic dissociation of calcium hydroxide into calcium ions and hydroxyl ions. (54.11% and 45.89% respectively) • Hydroxyl ions induces chemical injury on the organic components of the cytoplasmic membrane of the bacteria, causing destruction of phospholipids or unsaturated fatty acids.
  • 52. phoshphatase which is responsible for • Dentin Bridge Formation (Pulp Capping) • Activates enzymes such as alkaline mineralization • Free calcium hydroxide helps in remineralization of carious dentin
  • 53. ADVANTAGES DISADVANTAGES Easy manipulation Low strength even when fully set Rapidly harden in thin layers Exhibit plastic deformation Good sealing ability Dissolve under acidic conditions Beneficial effects on carious dentin and exposed pulp
  • 54. LIGHT ACTIVATEDCALCIUM HYDROXIDE • Recently introduced cement COMPOSITION • They have longer working time Calcium Hydroxide Barium sulphate Radio-opacifier Urethane dimethacrylate HEMA Activators – camphorquinone
  • 55. ADVANTAGES Less brittle than conventional 2 paste system Improved strength No solubility in acids Minimal solubility in water Longer working time
  • 56. DYCAL • Introduced in 1979 • As a liner/pulp capping agent in deep cavities • Radio-opaque calcium hydroxide which is self setting ADVANTAGES DISADVANTAGES High early strength Lower water solubility Excellent handling characteristics
  • 57.
  • 58. SILICATE CEMENTS (ADA SP . NO. 96) • Fletcher in 1871 • Oldest direct tooth colored materials • Steenbock later introduced an improved version of the cement COMPOSITION POWDER LIQUID Silicon Dioxide 35 – 50% Phosphoric acid Sodium fluoride Sodium & Aluminium phosphate Calcium fluoride Aluminium fluoride Aluminium trioxide Sodium fluoride
  • 59. SETTING REACTION • Acid – Base Reaction • Powder particles are attacked by acid releasing Calcium, aluminium and fluoride ions. • These ions precipitate as phosphates which form continuous cement matrix along with and forms a silica gel. • Fluoride ions donot take part in this reaction. Present as free ions. • Most of the powder particles are not dissolved, only the surfaces are dissolved. • Finally the set cement contains a phosphate matrix containing unreacted powder particles surrounded by acid gel and fluoride ions.
  • 60. PROPERTIES • Anticariogenic : large amounts of fluoride • Soluble in saliva. High in acidic conditions • Coefficient of thermal expansion: close to tooth structure : Microleakage is minimal • Good optical properties • pH remains low as 3 for few days : pulpal irritation • pH remains below 7 even after a month: severe pulpal irritant • Adhesion : mechanical bonding to tooth structure
  • 61. ADVANTAGES DISADVANTAGES Translucency High pulpal irritant Anticariogenic Highly soluble
  • 62. POL YCARBOXYLATE CEMENT (ADA SP . NO. 96) • Dennis Smith : 1968 • First cement system with adhesive bond to tooth structure • Also known as polyacrylate cement APPLICATION • Luting alloy restorations • Thermal insulating bases • Cementing orthodontic bands • Cementing SS crown in pediatric dentistry
  • 63. COMPOSITION POWDER % ZnO SnO / MgO 1 – 5 Aluminium oxide 10 – 40 Stannous Fluoride : Modified setting time LIQUID 40% Aqueous solution of Polyacrylic Acid
  • 64. SETTING REACTION • Powder particles are attacked by the acid releasing Zn, Mg, Sn ions. • Ions bind to the polymer chain via the carboxyl groups. • Ions also react with carboxyl group of adjacent polyacid chains to form cross linked salts. Bonding to tooth • Polyacrylic acid reacts with Calcium ions via the carboxyl groups on the surface of enamel and dentin.
  • 65. MANIPULATION • P:L = 1.5g : 1ml • Mixing should be done on a surface that do not absorb liquid. • Most of the powder should be incorporated into the liquid in one large increment. • Mixed over a small area with a stiff spatula • More powder is then added to obtain the required consistency • Mix should be used while it is still in the glossy state. • Mixed rapidly in 30 – 40 secs • Working time : 2.5 – 3.5 mins • Setting time : 6-9mins (at 37°C)
  • 66. Methods to Increase the working time • Cooling glass slab : • Thickening of the liquid • Difficulty in mixing • Powder refridgerated before mixing • Reaction occurs on cool surface, cool temperature retards the reaction without thickening of the liquid.
  • 67. PROPERTIES • Solubility in water is low • In organic acid with pH < 4.5 : increased solubility • Reduced P:L ratio : increases solubility in oral cavity Film Thickness 25 µm Compressive Strength 55 - 85 Mpa Tensile Strength 8 - 12 Mpa Modulus of elasticity 6 Gpa Bond strength to enamel 3.4 – 4.7 Mpa Bond strength to dentin 2.1 Mpa Thermal diffusivity 0.223mm2/sec
  • 68. BIOLOGIC EFFECTS • Good biocompatibility • Low intrinsic toxicity • Rapid rise in pH towards neutrality • Fluoride release
  • 69. ADVANTAGES DISADVANTAGES Low irritation Lower compressive strength Chemical bond to tooth structure and alloys Greater viscoelasticity Easy manipulation Need for clean surfaces for adhesion Adequate strength Short working time Low solubility Adequate film thickness Anticariogenic
  • 70. • Glass polyalkenoate cement is the proper designation for specialized glass powders that react with polyacrylic acid. However, glass ionomer, glass-ionomer cement, and GIC are recognized as acceptable names within the dental profession • The glass-ionomer cements are an improvement over the predecessor silicate cements because they include the bonding mechanism found in the zinc carboxylate cement with glass powder. • The result is a superior and versatile material that is adherent, translucent, and fluoride releasing. GLASS IONOMER CEMENTS(GIC)
  • 71.
  • 72. GICs have been used for (1) the esthetic restoration of anterior teeth (e.g., class III and V sites), (2) adhesive cements for fixed prosthe-ses and orthodontic appliances, (3) intermediate restorations, (4) pit and fissure sealants, (5) cavity liners and bases, and (6) core buildup materials
  • 74. • A nonabsorbent paper pad or a cool, dry glass slab may be used for mixing GIC. • The powder and liquid should be dispensed just before mixing is begun; otherwise, evaporation of water increases the acidity of the liquid. The powder should be rapidly spatulated into the liquid in less than 45 seconds, or as prescribed in the instructions for use • Normally, one-half of the powder is mixed into the liquid for 5 to 15 seconds; then the remaining powder is quickly added and mixed by folding the cement on itself until a uniform and glossy appearance is observed
  • 75.
  • 76.
  • 77. ACRYLIC RESINCEMENT APPLICATION • Cementation of restorations, facings and crowns COMPOSITION POWDER MMA polymer or Copolymer Benzyl Peroxide Mineral Filler Pigments LIQUID MMA monomer Amine Accelerators
  • 78. MANIPULATION • Liquid is added to powder with minimal spatulation to avoid incorporation of air. • Short working time – mix must be used immediately • Excess material is removed only after final set. • When cement is hard, and not when rubbery since it creates marginal deficiencies.
  • 79. PROPERTIES • Stronger and less soluble • Low rigidity and visco-elastic properties • No effective bond to the tooth structure in the presence of moisture BIOLOGIC EFFECTS • Marked pulpal response
  • 80. ADVANTAGES DISADVANTAGES High strength Marked pulpal irritation High toughness Short working time Low solubility Difficulty in removal of the excess cement
  • 81. ADHESIVE RESINCEMENT • Formulated by adding the following to MMA monomer: • 4 methacryloxy ethyl trimellitate anhydride (4-META) • Tributyl boron initiator (helps in adhesion) APPLICATION • Luting FPD and base metal • Bonding amalgam to dentin and composite
  • 82. PROPERTIES • (similar to acrylic resin) • Stronger and less soluble • Low rigidity and visco-elastic properties • No effective bond to the tooth structure in the presence of moisture • Moderate strength and high deformation under a load. PROPERTIES • Marked pulpal response
  • 83. 99
  • 84. PURPOSE OF A CAVITY LINER / VARNISH • Serve as a physical barrier to ingress of bacteria/ bacterial byproducts. • To provide therapeutic effect such as antibacterial, anticariogenic or pulpal anodyne effect. • Provide barrier for protection of pulp from residual reactants diffusing out of a restoration. • Prevent oral fluids that may penetrate leaky restorations from reaching the pulp through the dentin 84
  • 85. CAVITYVARNISH • A solution of one or more resins which when applied to the cavity walls, evaporates, leaving a thin resin film that serves as a barrier between the restoration and the dentinal tubules. APPLICATION • Prevents post-op sensitivity from galvanic shock • Minimize penetration of acid from zinc phosphate cements • Prevent diffusion of corrosion products from dental amalgam into dentin CONTRAINDICATION • Not to be used with Glass Ionomer Cement or Resin composites 85
  • 86. COMPOSITION 86 MANIPULATION • Applied by means of small cotton pellets / brush / applicator • 2 – 3 layers – sufficient protection • Volatile solvents evaporate quickly after application, leaving a thin resin film Solid Copal Resin, Rosin Or Synthetic Resin Solvent 90% Ether, Acetone Or Alcohol Medicinal Agent Chlorbutanol, Thymol, Eugenol
  • 87. PROPERTIES 87 Film thickness 1 – 4 µm Tensile strength < 1 Mpa Low solubility in water
  • 88. CAVITY LINER • Suspensions of calcium hydroxide in a volatile solvent. • Used like a cavity varnish to provide barrier against the passage of irritants from the cements and other restorative materials. COMPOSITION • Suspension of calcium hydroxide in an organic liquid such as methyl ethyl ketone or ethyl alcohol. 88
  • 89. PROPERTIES 89 • No significant thermal insulation • Soluble : should not be applied to margins of restorations • Fluoride compounds are added to newer compounds to prevent secondary caries Film thickness 1 – 4 µm Tensile strength < 1 Mpa
  • 90. MANIPULATION • (Similar to varnishes) • Applied by means of small cotton pellets / brush / applicator • 2 – 3 layers – sufficient protection • Volatile solvents evaporate quickly after application, leaving a thin resin film 90 Other Liners • Type III Glass Ionomer Cement • Type IV Zinc Oxide Eugenol
  • 91. BASES 91 • Material that is used to protect the pulp in a prepared cavity by providing thermal insulation • Ie these are those cements commonly used in thicker dimensions beneath permanent restorations to provide for mechanical, chemical and thermal protection to the pulp. • Eg: • Zinc Phosphate • Zinc Oxide Eugenol • Calcium Hydroxide • Zinc Polycarboxylate • Glass Ionomer
  • 92. INDICATIONS OF A CAVITY BASE • To protect the pulp against thermal injury, galvanic shock and chemical irritation. (Zinc phosphate under amalgam restoration) • To withstand the forces of condensation of the restorative material and act as shock absorbers. (Zinc phosphate under amalgam restoration) • To substitute dentin in deep cavities. (all high strength bases) • To serve as intermediate bonding material between the tooth and composite restoration. (GIC in sandwich technique) 92
  • 93. CLASSIFICATION 93 • Low strength bases • Zinc oxide Eugenol, calcium hydroxides • Calcium hydroxide as a sub-base • High strength bases • GIC, reinforced ZOE, Zinc phosphate, Zinc polycarboxylate • Used under direct and indirect metallic restorations • Only some bases are indicated under composite resins (GIC)
  • 94. CLINICAL CONSIDERATIONS 94 Clinician must observe certain general guidelines for placement of bases: • Base should be 0.5 – 0.75mm thick. • Very thick bases compromise the bulk of the restoration • Increase the potential for fracture of the restoration • It is not recommended to remove sound tooth structure inorder to provide space for a base • Bases are applied only on internal walls of the cavity preparation to prevent dissolution by saliva
  • 95. CONCLUSION 95 • No single type of cement satisfies all of the ideal requirements or is best suited for all indications in dentistry • Each situation must be evaluated based on the environmental, mechanical and biological factors and finally decide on which material to be used in each case.
  • 96. REFERENCES 96 • Phillip’s Science of Dental Materials : Anusavice ( 12th Edition ) • Phillip’s Science of Dental Materials : Anusavice ( 10th Edition ) • Craig’s Restorative Dental Materials ( 13th Edition ) • Craig’s Restorative Dental Materials ( 12th Edition ) • Dental Materials and their Selection : William J O’Brien ( 4th Edition ) • Materials Used in Dentistry : S.Mahalexmi ( 1st Edition )
  • 97. Dental Cements - Dr. Nithin Mathew