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Dental Cements
Dr. Deepak K Gupta
Dental Cements
• They are materials that set intraorally and that
are commonly used to join a tooth and a
prosthesis or restoration of carious tooth.
• The use of dental cements:
– Luting/cementation of prosthesis and orthodontic
appliance
– Restoration
– Pulp Therapy
– Obtundant
– Liners & Bases
– Root canal sealers
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Classification based on Application
• Type I : Luting agents
– Type I : Fine grain for cementation and luting
– Type II : Medium grain for bases, orthodontic
purposes
• Type II : Restorative application
• Type III : Liners or base applications
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Classification based on bonding
Mechanism
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General Properties : Strength
• Tensile Stress: a
stress caused by a
load that tends to
stretch or elongate a
body.
• Compressive Stress :
associated with a
compressive strain.
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General Properties : Strength
• Shear stress : resist the
sliding or twisting of one
portion of a body over
another.
• Flexural Stress : Caused
due to bending of a body in
the opposite direction of
bend.
• All this stresses act in
combination on cements
depending on nature and
direction of force.
• The ability to withstand this
stresses comprises of
strength of cement facebook.com/notesdental
General Properties : Modulus of
elasticity (MOE)
• Measure of
stiffness of
cement.
• Ability to return
back to its
original shape
after the
deformative force
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General Properties: Solubility and
disintegration
• Long term survivability
of restorations.
• Solubility and
disintegration of cement
lead at the margin leads
to inflammation,
secondary caries or
sensitivity
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General properties : Film thickness
• A thinner film is more advantageous for luting.
• It depends on various factors
– Particles Size
– P/L ratio
– amount of force applied during seating of the
prosthesis.
– Direction in which force is applied
– Design and fit of prosthesis
• ADA sp. No. 96 recommends acceptable
thickness of 50 µm
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Biological properties
• pH : ideally it should be neutral, but most of
cements are acidic but it loses its acidity
gradually with time
• Pulpal response : mild to moderate response
is acceptable depending on its use
• Pulp protection : it should not irritate the
pulp. So its advised not to use to thin mixes
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Acid – Base Cement
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Acid – Base Cement
• It can be either
– Non-Eugenol
• Zinc Phosphate
• Zinc polycarboxylate
• Glass ionomer
• Resin-modifid glass ionomer
• Compomer
– Eugenol Based
• Zinc oxide–eugenol
• Zinc oxide–eugenol (EBA
modifid)
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Zinc Phosphate Cement
• First cement appearing
in literature.
• USE
– Permanent cement for
indirect restorations
including inlays, onlays,
crowns, and bridges
– Orthodontic cement
– High-strength base
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Zinc Phosphate Cement : Composition
Powder
Zinc Oxide > 75 % Main Constituents
Magnesium Oxide 13 % Aids in sintering
Barium oxides 0.2 % Radioopacity
Other oxides (Bismuth
trioxide, Calcium oxide)
1.4 % Smoothness of mix and fillers
Liquid
Phosphoric Acid 38 % – 59 % Reacts with ZnO
Water 30% to 55% Controls the rate of reaction
Alumuminium Phosphate 2% to 3% Buffer
Zinc phosphate (up to 10%)
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Setting Reaction
• When mixed, phosphoric acid dissolves the
zinc oxide, which reacts with the aluminum
phosphate and forms zinc aluminophosphate
gel on the remaining undissolved zinc
oxide particles.
• Mixing Time : 1.5 – 2 min
• Setting Time : 2.5 – 8 min
• Exothermic Reaction
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Control of setting time
• Manufacturing process
• Sintering temperature : directly proportional
• Particle size : inversely
• Water content : inversely
• Buffering agent : directly
• Operator control
• Temperature : inversely
• p/l ratio : directly
• Rate of addition of powder to liquid : directly
• Mixing time : directly
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Properties
• C.S. = 104 – 119 MPa
– 70 % strength in 30 min, max in 24 hrs
– More the powder, greater strength.
– Water content: both loss or gain reduces the
strength.
• T.S. = 5.5 MPa, brittle
• MOE = 13.7 GPa, stiff and resistant to elastic
deformation
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Properties
• Solubility = 0.06 % - low
– Thick mix : less solubility
– Water content : any change increases the solublity
– Moisture : increases
• Film Thickness =
• Thermal insulator - good
• Adhesion properties – micromechanical
• pH = 2 (at time of cementation) , 5.5 (24 hrs)
• Pulpal response – moderate
• Pulp protection – RDT 1.5 mm
• Avoid thin mixes
• Liners & bases : ZOE, CaOH, cavity varnish
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Clinical Manipulation
• Obtain a clean, cool, dry glass slab and flexible cement spatula.
• Fluff the powder and dispense appropriate amount for
cementation.
• Divide the powder in 1/2, then into 1/4, then divide one of the
fourths into 1/8, and then one of the eighths into 1/16.
• Dispense the liquid (6 to 12 drops) holding the dropper vertical to
the glass slab.
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Clinical Manipulation
• Incorporate 1/16 portion of powder into
the liquid and mix for 15 seconds. Repeat
by adding the 2nd 1/16 and
mix for 15 seconds.
• Add the eighth portion and mix the
material using three quarters of the glass
slab for 15 second
• Add one of the quarters and spatulate for
20 seconds; follow by a second quarter,
which is also spatulated for 20 seconds.
• Add enough of the last quarter of powder
to achieve the consistency the dentist
requires. Mix should be completed in
2 minutes.
• Ropy consistency for restoration and putty
like consistency for base application.
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Advantage and disadvantage
• Advantage
– Proven reliablity
– Good C.S.
• Disadvantage
• No chemical adhesion
• No anticariogenic properties
• Pulp irritation
• Poor esthetics
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Zinc Polycarboxylate
• First dental cement to
exhibit chemical
bonding to teeth.
• Not used for restorative
purposes because the
cement is opaque
• USE
– Permanent cement for
crowns, bridges, inlays,
and onlays
– Orthodontic
cementation
– High-strength base
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Zinc Polycarboxylate Cement : Composition
Powder
Zinc Oxide 89 % Main Constituents
Magnesium Oxide 9 % Aids in sintering
Barium oxides 0.2 % Radioopacity
Other oxides (Bismuth
trioxide, Calcium oxide)
1.4 % Smoothness of mix and fillers
Liquid
Polyacrylic acid or a
copolymer of acrylic acid
32 % – 48 % Reacts with ZnO
Other carboxylic acids,
such as itaconic acid or
maleic acid
30% to 55% Controls the rate of reaction
Stannous floride - adjust the setting time & increase the
strength
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Setting Reaction
• Setting begins by dissolution of the powder particles by
the acid, which releases zinc, magnesium, and tin ions;
• These bind and cross-link the carboxyl groups.
• The result is a cross-linked polycarboxylate matrix
phase encapsulating the unreacted portion of the
particles.
• The hardened zinc polycarboxylate cement is an
amorphous gel matrix in which unreacted powder
particles
are dispersed.
• Mixing Time : 30 seconds – 2 min
• Setting Time : 6 to 9 min
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Properties
• C.S. = 55 MPa
• T.S. = 6.2 MPa, less brittle
• pH : rapidly rises from 3 to 6
• Pulpal response : mild
• Pulp protection : less irritation as the particle
size and molecular weight is higher and the
acidic content is neutralized rapidly.
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Properties
• Solubility = 0.6 % - more soluble than zinc
phosphate
– Marginal dissolution is more which increases in acids
like lactic acid.
– Low p/l increases the solubility
• Thermal insulator - good
• Adhesion properties – micromechanical &
chemical (carboxyl group of tooth structure)
• Opaque
• Anticariogenic properties – less as compared to
GIC.
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Clinical Manipulation
• Obtain a clean, cool, dry glass slab and flexible cement spatula.
• Fluff the powder and dispense appropriate amount for
cementation.
• Divide the powder in 1/2, then into 1/4, then divide one of the
fourths into 1/8, and then one of the eighths into 1/16.
• Dispense the liquid (6 to 12 drops) holding the dropper vertical to
the glass slab.
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Clinical Manipulation
• Incorporate 1/16 portion of powder into
the liquid and mix for 15 seconds. Repeat
by adding the 2nd 1/16 and
mix for 15 seconds.
• Add the eighth portion and mix the
material using three quarters of the glass
slab for 15 second
• Add one of the quarters and spatulate for
20 seconds; follow by a second quarter,
which is also spatulated for 20 seconds.
• Add enough of the last quarter of powder
to achieve the consistency the dentist
requires. Mix should be completed in
2 minutes.
• Ropy consistency for restoration and putty
like consistency for base application.
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Advantage and disadvantage
• Advantage
– Chemical bonding
– Good marginal adaptation
– Anticariogenic properties
– Mildly acidic
• Disadvantage
• Less C.S.
• Poor esthetic
• Solublity high
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Glass Ionomer Cement
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Introduction
• developed in the 1970s
• tooth colored, anticariogenic
restorative materials
• combined properties of silicate
cements and poly carboxylate
cements
• minimal cavity preparation as it
bonds adhesively to tooth structure
• Why glass ionomer cement ?
– the powder is glass
– the setting reaction and adhesive
bonding to tooth
structure is due to ionic bond
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Introduction
• Synonyms
– Poly (alkenoate) cement
– ASPA (alumino silicate polyacrylic acid)
• Commercial preparation
– Aquacem,
– Fugi I — Type I
– Chem Fil — Type II
– Ketac bond — Type III
– Vitra bond — Light cure GIC
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Classification of Glass Ionomer
Cement (GIC)
• Type I: Luting crowns, bridges, and
orthodontic brackets
• Type IIa: Esthetic restorative cements
• Type IIb: Reinforced restorative cements
• Type III: Lining cements, base
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Glass Ionomer Cement : Composition
Powder
Silica (SiO)2 41.9
Alumina (Al2O3) 28.6
Aluminium flouride (AlF3) 1.6
Calcium flouride (CaF2) 15.7
Sodium flouride (NaF) 9.3
Aluminium phosphate (AlPO4) 3.8
Barium/strontium oxide radiopacity
Liquid
Polyacrylic acid or a
copolymer of acrylic acid
40-50 % Reacts with SiO and Al203
Other carboxylic acids, such
as itaconic acid or maleic
acid
30% to 55% Controls the rate of reaction
Tartaric acid rate-controlling additive
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Chemistry: Setting Reaction
• Powder and liquid are mixed together
• Acid attacks the glass particles leaching calcium,
aluminium, sodium and flouride ions into the
aqueous medium.
• Polyacrylic acid chains - cross-linked by the Al
ions
• Sodium and fluorine 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 gelfacebook.com/notesdental
Chemistry: Mechanism of Adhesion
• Chelation of the carboxyl
groups of the polyacrylic
acids with the calcium -
apatite of the enamel and
dentin
• Similar to polycarboxylate
cement
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CLINICAL MANIPULATION
• Surface Preparation
– Pumice slurry: remove the smear layer produced
by cavity preparation
– Tooth may be etched for 10 sec
• phosphoric acid (34% to 37%)
• organic acid like polyacrylic acid (10% to 20%)
– Followed by a 20- to 30-second water rinse
– Dried but not desiccated
– Must remain uncontaminated by saliva or blood
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CLINICAL MANIPULATION
• Material Preparation
– supplied in two bottles
(powder and liquid) or
capsules containing
preproportioned powder and
liquid
– P/L ratio recommended by the
manufacturer should be
followed
– powder should be
incorporated rapidly into the
liquid using a stiff spatula
(AGATE) on a cool paper pad
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CLINICAL MANIPULATION
• Normally half of the powder is mixed into
the liquid for 5 to 15 seconds
• rest of the powder is then quickly added
• Mixed until a uniform, glossy appearance:
indicates the presence of unreacted polyacid,
which is critical for bonding to the tooth.
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CLINICAL MANIPULATION
• Placement of Material
– slightly overfilled with GIC restorative
– Surface should be covered with a plastic matrix for
about 5 minutes - protect the material from
gaining or losing water during the initial set
– surface must immediately be protected with the
varnish supplied with the GIC or with petroleum
gelly
– excess GIC is removed from the margins
– Finishing is improved as the cement sets
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PROPERTIES
• Setting Time
– Type I — 4-5 minutes
– Type II — 7 minutes
• Release of Fluoride
• release fluoride in amounts comparable to those released
initially from silicate cement
• inhibit enamel and dentin demineralization
• But its clinical efficacy is yet to be proved, where it shows
anticariogenicity in vitro
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PROPERTIES
• Greater pulpal reaction than ZOE cement but
less than zinc phosphate cement
• luting agents pose a greater pulpal hazard
than restorative agents
• Protective liner such as Ca(OH)2 should be
used if the preparation is closer than 0.5 mm
to the pulp chamber
• Compressive strength is similar to that of zinc
phosphate
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PROPERTIES
• Modulus of elasticity is only about half that of
zinc phosphate cement
– less stiff and more susceptible to elastic
deformation
– less desirable than zinc phosphate cement to
support an all-ceramic crown
• greater tensile stress could develop in the crown that is
supported by the GIC under occlusal loading
• More vulnerable to wear than are composites
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Modification of GIC
• Metal-reinforced GIC
• High-viscosity GIC
• Resin-modified GIC (hybrid ionomer)
• Calcium aluminate GIC
• Compomer
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METAL-REINFORCED GLASS IONOMER
CEMENTS
• Metallic fillers - improve their fracture
toughness and stress-bearing capacity
• Silver alloy powder or particles of silver
sintered to glass
• Grayish and more radiopaque
• Also known as alloy admixture and cermet.
• Fluoride release rate decreases over time.
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METAL-REINFORCED GIC : Types
• Silver alloy admixed: Spherical amalgam alloy
powder is mixed with type II GIC powder
– Ex: Miracle Mix
• Cermet: Silver particles are bonded to glass
particles.
– Done by sintering of a mixture of the two powders
at a high temperature
– Ex: Ketac Silver
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METAL-REINFORCED GLASS IONOMER
CEMENTS
• Adhesion and fluoride release
– useful for core buildups of teeth – occlusal
surfaces of primary molars
• Compared with conventional glass ionomers
or amalgam or compites
– It exhibit no improvement in clinical performance
and life expectancy
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HIGH-VISCOSITY GLASS IONOMER
CEMENT
• Atraumatic restorative treatment (ART)
– preventive and restorative caries management
– Where electricity or piped water systems is absent
– hand instruments for opening tooth cavities.
• GIC remains the choice of filling material in ART
• Releases fluoride and bonds chemically to tooth structure
• Conventional GIC was low in viscosity to flow in
non-prepared carious portion of teeth
• So high viscosity GIC was developed in an attempt to overcome
these difficulty
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HIGH-VISCOSITY GLASS IONOMER
CEMENT
• Contain smaller glass particle sizes and use a
higher P/L ratio,
• Greater compressive strength
• Excellent packability for better handling
characteristics.
• Indication
– Core buildups,
– Primary tooth fillings,
– Non-stress-bearing restorations,
– Intermediate restorations
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RESIN-MODIFIED GLASS IONOMER
CEMENT (HYBRID IONOMER)
• Water-soluble methacrylate-based monomers -
replace part of liquid component of conventional
GIC.
• Also known as hybrid ionomer cement
• Monomers can be polymerized - chemical or light
activation or both.
• Also contain nonreactive filler particles -
lengthens the working time
– improves early strength
– makes the cement less sensitive to moisture during
setting
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RESIN-MODIFIED GLASS IONOMER
CEMENT (HYBRID IONOMER)
• Liquid
– water solution of polyacrylic acid,
HEMA
– polyacrylic acid modified with
methacrylate
• Powder: same as that for
conventional GICs in addition to
initiators, such as camphorquinone.
• Sandwich technique:
– resin-modified glass ionomer to
seal the dentin
– It provides the benefit of fluoride
release
– Over which a layer of resin
composite is filled on the rest of
cavity
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Mechanism of Bonding
• Same as that for conventional GICs
• Hybrid layer: cement that infiltrates the tubules,
but no studies has got any conclusive evidence.
• Higher bond strengths – enhanced
micromechanical interlocking to the roughened
tooth surface
• Comparatively more microleakage
– More shrinkage of hybrid ionomers
– Low wettablity: lower water and carboxylic acid
contents
• Water resorption – by HEMA
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Clinical Manipulation
• Indication
– Liners, base materials,
– Fissure sealants,
– Core buildups,
– Restoratives,
– Adhesives for orthodontic brackets,
– Repair materials for damaged amalgam cores or
cusps,
– Retrograde root filling materials
• Surface conditioning of the tooth structure with
a mild acid - bond formation
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CALCIUM ALUMINATE GIC
• Hybrid product with a composition between that
of calcium aluminate and GIC
• Luting fixed prostheses
• calcium aluminate component is made by
sintering a mixture of high-purity Al2O3 and CaO.
• Powder: calcium aluminate, polyacrylic acid,
tartaric acid, strontium-fluoro-alumino-glass, and
strontium fluoride
• Liquid: liquid component contains 99.6% water
and 0.4% additives
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COMPOMER
• Polyacid-modified composite made by
incorporating glass particles of GIC.
• Water-free polyacid liquid monomer with
appropriate initiator.
• Properties distinctly different from those of
composites and GIC
• Rationale
– integration of the fluoride-releasing capability of GIC
– Durability of composites
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CHEMISTRY AND SETTING
• Usually one-paste, light-cure materials - restorative
applications
• Powder-liquid systems: luting applications
• These water free materials contain
– nonreactive inorganic filler particles,
– reactive silicate glass particles,
– sodium fluoride,
– polyacidmodified monomers: diester of 2-hydroxyl methacrylate
with butane carboxylic acid and photoactivators.
• Setting of one-component compomers is initiated by
photopolymerization of the acidic monomer.
• Sensitive to moisture
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CHEMISTRY AND SETTING
• Functionally hydrophobic
• To a lesser extent, and intraorally they absorb
water from the saliva
• These begins the slow acid base reaction of GIC
• Powder: strontia-alumina-fluorosilicate glass,
metallic oxides, and initiators (chemical/ light/
dual cure)
• Liquid: polymerizable methacrylate/carboxylic
monomers, multifunctional acrylate monomers
and water.
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CLINICAL MANIPULATION
• Bonding Mechanism
– One-paste - require a dentin-bonding agent - do
not contain water (self-adhesive)
– Bond strength of one-paste compomers similar to
or higher than that of hybrid ionomers.
– Powder-liquid compomer: cements for luting are
self-adhesive, because water in the liquid makes
the mixture acidic, like hybrid ionomers.
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CLINICAL MANIPULATION
• Restorative compomer
– Low stress-bearing areas such as Class III and V prepared cavity,
– Alternative to glass ionomer restoratives
– Resin based composites.
– Etching should be done
– Finished just like resin composites.
• Luting systems
– Prostheses with a metallic substrate.
– The cement mixture is placed only on the prosthesis - seated with
finger pressure.
– The margin should be light-cured immediately to stabilize the
prosthesis.
– The chemical-cure compomers complete their setting reaction in
approximately 3 minutes in the oral environment
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RESIN CEMENTS
• Low-viscosity versions of
restorative composites.
• Virtually insoluble in oral
fluids.
• ISO classifies resin cements
according to curing mode as
– class 1 (self-cured)
– class 2 (light-cured)
– class 3 (dual-cured)
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RESIN CEMENTS
• APPLICATIONS
– Cementation of crowns and
bridges (etched cast
restorations)
– Cementation of porcelain
veneers and inlays.
– For bonding of orthodontic
brackets to acid-etched
enamel
• Commercial Names
– Panavia Ex
– Infinity
– Porcelite dual cure (Kerr)
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COMPOSITION
• Powder
– Resin matrix (diacrylate monomer, Bis-GMA, UDMA,
TEGDMA)
– Inorganic fillers
– Coupling agent (organo silane)
– Chemical or photo initiators and activators
(Camphorquinone, a tertiary amine, Benzoyl peroxide)
– tri-n-butylborane (TBB) as catalyst
• Liquid
– Methyl methacrylate
– Tertiary amine.
– 4-META, MDP
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CLINICAL MANIPULATION
• monomeric component irritating to the pulp - pulp
protection with a liner.
• Chemically cured resin cements
– all types of restorations
– supplied as powder and liquid or two pastes,
– mixed on a paper pad for 20 to 30 seconds.
– slow and provides extended working time,
• Dual-cure cements
– mixing similar to that for the chemical-cure systems.
– Curing proceeds slowly until the cement is exposed to the
curing light
– Should not be used in prostheses thicker than 2.5 mm
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CLINICAL MANIPULATION: treatment
of the prosthesis
• Metallic Prostheses
– roughened by electrochemical etching or by grit blasting with 30- to
50-µm alumina particles at an air pressure
• Polymeric Prostheses
– polymer’s surface should be grit-blasted to increase the roughness for
mechanical adhesion
• Ceramic Prostheses
– Some dental ceramic restorations are translucent – shade of luting
agent must be matched.
– Silica based (feldspathic porcelain): etched with hydrofluoric acid and
a silane coating is applied prior to cementation,
– Alumina and zirconia-based ceramics: grit blasting
• Orthodontic Brackets
– mechanical retention, such as the metal mesh of a metal bracket or
retentive dimples or ridges on ceramic or polymer brackets
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ZINC OXIDE−EUGENOL CEMENT
• Used for luting and intermediate restorations because of
its medicament quality and neutral
pH.
• Cements of low strength
• To improve the strength many modification have been
introduced
– EBA—alumina modified
– Polymer—reinforced zinc oxide-eugenol cements.
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ZINC OXIDE−EUGENOL CEMENT
• ANSI/ADA Specification No. 30
– Type I: temporary cementation;
– Type II: long-term cementation of fixed
prostheses;
– Type III: temporary fillings and thermal insulating
bases;
– Type IV: intermediate fillings
• Also used as a root canal sealer and
periodontal dressings.
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ZINC OXIDE−EUGENOL CEMENT
• Commercial Names
– Unmodified: Tempac –
Type III, Cavitic – Type
IV, Temp bond – Type I
– EBA alumina modified:
Opotow Alumina EBA –
Type II
– Polymer modified:
Fynal – Type II, IRM –
Type III
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Composition
• Formulated as a powder-liquid or two-paste
system.
• Powder or Base Paste: zinc oxide particles.
• Liquid or Accelerator Paste: eugenol.
• Water in the eugenol solution that hydrolyzes the zinc
oxide to form zinc hydroxide.
• Zinc hydroxide and eugenol chelate and solidify to form
zinc oxide eugenolate.
• Slow but proceeds more rapidly in a warm, humid
environment.
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Composition
• Best suited for provisional applications.
• Residual free eugenol interferes with the proper
setting of resin-based composites or resin
cements.
• Various types of carboxylic acids have been used
to replace eugenol and produce a ZOE-like
material.
• Zinc oxide-noneugenol cements
– EBA-Alumina modified cements
– ZOE plus polymer
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Modification
• EBA-ALUMINA MODIFIED CEMENTS
– Liquid: substituted by orthoethoxybenzoic acid (EBA)
for part of the eugenol liquid
– Powder: alumina
• ZOE plus polymer
– Liquid: eugenol
– Powder: 20% to 40%: fine polymer particles
• Zinc oxide particles - surface treated with carboxylic acid
• Compressive strength (CS): acceptable but their
strength values are inferior to those of zinc
phosphate, glass ionomer, and resin cements
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CLINICAL MANIPULATION
• Temporary ZOE cements
– luting provisional acrylic crowns and fixed partial dentures.
– last a few weeks at most
– seal the dentinal tubules surprisingly well against the ingress of oral
fluids and have a sedative effect on the pulp
– can cause pulp necrosis and should not be used directly on a pulp
• Intermediate Restoration
– When mixed to a stiff putty like consistency
– Restorative material for at least a year.
– cool glass slab slows the setting to enable the formation of a thick
consistency,
– not be colder than the dew point- water will condense onto the
cement and accelerate the reaction
• ZOE luting cements: high film thicknesses
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MINERAL TRIOXIDE AGGREGATE
CEMENTS
• A new category of cement –
based on Portland cement
• Good sealing ability and
biocompatibility.
• Contains oxides in
hydraulically active ceramic
compound
– Calcium oxide (calcia, CaO),
– Aluminum oxide (alumina,
Al2O3)
– Silicon dioxide (silica, SiO2)
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MINERAL TRIOXIDE AGGREGATE
CEMENTS
• Indication
– Pulp capping
– Apexification
– Apexogenesis
– Root canal sealers
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References
• Phillips' Science of Dental Materials- Phillip
Anusavice_12th
• Basic Dental Materials -2nd.ed Mannapalli
• Clinical Aspects of Dental Materials Theory,
Practice, and Cases, 4th Edition
• Craig's Restorative Dental Material 13th
edition
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THANKS……
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Dental cements1

  • 2. Dental Cements • They are materials that set intraorally and that are commonly used to join a tooth and a prosthesis or restoration of carious tooth. • The use of dental cements: – Luting/cementation of prosthesis and orthodontic appliance – Restoration – Pulp Therapy – Obtundant – Liners & Bases – Root canal sealers facebook.com/notesdental
  • 3. Classification based on Application • Type I : Luting agents – Type I : Fine grain for cementation and luting – Type II : Medium grain for bases, orthodontic purposes • Type II : Restorative application • Type III : Liners or base applications facebook.com/notesdental
  • 4. Classification based on bonding Mechanism facebook.com/notesdental
  • 5. General Properties : Strength • Tensile Stress: a stress caused by a load that tends to stretch or elongate a body. • Compressive Stress : associated with a compressive strain. facebook.com/notesdental
  • 6. General Properties : Strength • Shear stress : resist the sliding or twisting of one portion of a body over another. • Flexural Stress : Caused due to bending of a body in the opposite direction of bend. • All this stresses act in combination on cements depending on nature and direction of force. • The ability to withstand this stresses comprises of strength of cement facebook.com/notesdental
  • 7. General Properties : Modulus of elasticity (MOE) • Measure of stiffness of cement. • Ability to return back to its original shape after the deformative force facebook.com/notesdental
  • 8. General Properties: Solubility and disintegration • Long term survivability of restorations. • Solubility and disintegration of cement lead at the margin leads to inflammation, secondary caries or sensitivity facebook.com/notesdental
  • 9. General properties : Film thickness • A thinner film is more advantageous for luting. • It depends on various factors – Particles Size – P/L ratio – amount of force applied during seating of the prosthesis. – Direction in which force is applied – Design and fit of prosthesis • ADA sp. No. 96 recommends acceptable thickness of 50 µm facebook.com/notesdental
  • 10. Biological properties • pH : ideally it should be neutral, but most of cements are acidic but it loses its acidity gradually with time • Pulpal response : mild to moderate response is acceptable depending on its use • Pulp protection : it should not irritate the pulp. So its advised not to use to thin mixes facebook.com/notesdental
  • 11. Acid – Base Cement facebook.com/notesdental
  • 12. Acid – Base Cement • It can be either – Non-Eugenol • Zinc Phosphate • Zinc polycarboxylate • Glass ionomer • Resin-modifid glass ionomer • Compomer – Eugenol Based • Zinc oxide–eugenol • Zinc oxide–eugenol (EBA modifid) facebook.com/notesdental
  • 13. Zinc Phosphate Cement • First cement appearing in literature. • USE – Permanent cement for indirect restorations including inlays, onlays, crowns, and bridges – Orthodontic cement – High-strength base facebook.com/notesdental
  • 14. Zinc Phosphate Cement : Composition Powder Zinc Oxide > 75 % Main Constituents Magnesium Oxide 13 % Aids in sintering Barium oxides 0.2 % Radioopacity Other oxides (Bismuth trioxide, Calcium oxide) 1.4 % Smoothness of mix and fillers Liquid Phosphoric Acid 38 % – 59 % Reacts with ZnO Water 30% to 55% Controls the rate of reaction Alumuminium Phosphate 2% to 3% Buffer Zinc phosphate (up to 10%) facebook.com/notesdental
  • 15. Setting Reaction • When mixed, phosphoric acid dissolves the zinc oxide, which reacts with the aluminum phosphate and forms zinc aluminophosphate gel on the remaining undissolved zinc oxide particles. • Mixing Time : 1.5 – 2 min • Setting Time : 2.5 – 8 min • Exothermic Reaction facebook.com/notesdental
  • 16. Control of setting time • Manufacturing process • Sintering temperature : directly proportional • Particle size : inversely • Water content : inversely • Buffering agent : directly • Operator control • Temperature : inversely • p/l ratio : directly • Rate of addition of powder to liquid : directly • Mixing time : directly facebook.com/notesdental
  • 17. Properties • C.S. = 104 – 119 MPa – 70 % strength in 30 min, max in 24 hrs – More the powder, greater strength. – Water content: both loss or gain reduces the strength. • T.S. = 5.5 MPa, brittle • MOE = 13.7 GPa, stiff and resistant to elastic deformation facebook.com/notesdental
  • 18. Properties • Solubility = 0.06 % - low – Thick mix : less solubility – Water content : any change increases the solublity – Moisture : increases • Film Thickness = • Thermal insulator - good • Adhesion properties – micromechanical • pH = 2 (at time of cementation) , 5.5 (24 hrs) • Pulpal response – moderate • Pulp protection – RDT 1.5 mm • Avoid thin mixes • Liners & bases : ZOE, CaOH, cavity varnish facebook.com/notesdental
  • 19. Clinical Manipulation • Obtain a clean, cool, dry glass slab and flexible cement spatula. • Fluff the powder and dispense appropriate amount for cementation. • Divide the powder in 1/2, then into 1/4, then divide one of the fourths into 1/8, and then one of the eighths into 1/16. • Dispense the liquid (6 to 12 drops) holding the dropper vertical to the glass slab. facebook.com/notesdental
  • 20. Clinical Manipulation • Incorporate 1/16 portion of powder into the liquid and mix for 15 seconds. Repeat by adding the 2nd 1/16 and mix for 15 seconds. • Add the eighth portion and mix the material using three quarters of the glass slab for 15 second • Add one of the quarters and spatulate for 20 seconds; follow by a second quarter, which is also spatulated for 20 seconds. • Add enough of the last quarter of powder to achieve the consistency the dentist requires. Mix should be completed in 2 minutes. • Ropy consistency for restoration and putty like consistency for base application. facebook.com/notesdental
  • 21. Advantage and disadvantage • Advantage – Proven reliablity – Good C.S. • Disadvantage • No chemical adhesion • No anticariogenic properties • Pulp irritation • Poor esthetics facebook.com/notesdental
  • 22. Zinc Polycarboxylate • First dental cement to exhibit chemical bonding to teeth. • Not used for restorative purposes because the cement is opaque • USE – Permanent cement for crowns, bridges, inlays, and onlays – Orthodontic cementation – High-strength base facebook.com/notesdental
  • 23. Zinc Polycarboxylate Cement : Composition Powder Zinc Oxide 89 % Main Constituents Magnesium Oxide 9 % Aids in sintering Barium oxides 0.2 % Radioopacity Other oxides (Bismuth trioxide, Calcium oxide) 1.4 % Smoothness of mix and fillers Liquid Polyacrylic acid or a copolymer of acrylic acid 32 % – 48 % Reacts with ZnO Other carboxylic acids, such as itaconic acid or maleic acid 30% to 55% Controls the rate of reaction Stannous floride - adjust the setting time & increase the strength facebook.com/notesdental
  • 24. Setting Reaction • Setting begins by dissolution of the powder particles by the acid, which releases zinc, magnesium, and tin ions; • These bind and cross-link the carboxyl groups. • The result is a cross-linked polycarboxylate matrix phase encapsulating the unreacted portion of the particles. • The hardened zinc polycarboxylate cement is an amorphous gel matrix in which unreacted powder particles are dispersed. • Mixing Time : 30 seconds – 2 min • Setting Time : 6 to 9 min facebook.com/notesdental
  • 25. Properties • C.S. = 55 MPa • T.S. = 6.2 MPa, less brittle • pH : rapidly rises from 3 to 6 • Pulpal response : mild • Pulp protection : less irritation as the particle size and molecular weight is higher and the acidic content is neutralized rapidly. facebook.com/notesdental
  • 26. Properties • Solubility = 0.6 % - more soluble than zinc phosphate – Marginal dissolution is more which increases in acids like lactic acid. – Low p/l increases the solubility • Thermal insulator - good • Adhesion properties – micromechanical & chemical (carboxyl group of tooth structure) • Opaque • Anticariogenic properties – less as compared to GIC. facebook.com/notesdental
  • 27. Clinical Manipulation • Obtain a clean, cool, dry glass slab and flexible cement spatula. • Fluff the powder and dispense appropriate amount for cementation. • Divide the powder in 1/2, then into 1/4, then divide one of the fourths into 1/8, and then one of the eighths into 1/16. • Dispense the liquid (6 to 12 drops) holding the dropper vertical to the glass slab. facebook.com/notesdental
  • 28. Clinical Manipulation • Incorporate 1/16 portion of powder into the liquid and mix for 15 seconds. Repeat by adding the 2nd 1/16 and mix for 15 seconds. • Add the eighth portion and mix the material using three quarters of the glass slab for 15 second • Add one of the quarters and spatulate for 20 seconds; follow by a second quarter, which is also spatulated for 20 seconds. • Add enough of the last quarter of powder to achieve the consistency the dentist requires. Mix should be completed in 2 minutes. • Ropy consistency for restoration and putty like consistency for base application. facebook.com/notesdental
  • 29. Advantage and disadvantage • Advantage – Chemical bonding – Good marginal adaptation – Anticariogenic properties – Mildly acidic • Disadvantage • Less C.S. • Poor esthetic • Solublity high facebook.com/notesdental
  • 31. Introduction • developed in the 1970s • tooth colored, anticariogenic restorative materials • combined properties of silicate cements and poly carboxylate cements • minimal cavity preparation as it bonds adhesively to tooth structure • Why glass ionomer cement ? – the powder is glass – the setting reaction and adhesive bonding to tooth structure is due to ionic bond facebook.com/notesdental
  • 32. Introduction • Synonyms – Poly (alkenoate) cement – ASPA (alumino silicate polyacrylic acid) • Commercial preparation – Aquacem, – Fugi I — Type I – Chem Fil — Type II – Ketac bond — Type III – Vitra bond — Light cure GIC facebook.com/notesdental
  • 34. Classification of Glass Ionomer Cement (GIC) • Type I: Luting crowns, bridges, and orthodontic brackets • Type IIa: Esthetic restorative cements • Type IIb: Reinforced restorative cements • Type III: Lining cements, base facebook.com/notesdental
  • 35. Glass Ionomer Cement : Composition Powder Silica (SiO)2 41.9 Alumina (Al2O3) 28.6 Aluminium flouride (AlF3) 1.6 Calcium flouride (CaF2) 15.7 Sodium flouride (NaF) 9.3 Aluminium phosphate (AlPO4) 3.8 Barium/strontium oxide radiopacity Liquid Polyacrylic acid or a copolymer of acrylic acid 40-50 % Reacts with SiO and Al203 Other carboxylic acids, such as itaconic acid or maleic acid 30% to 55% Controls the rate of reaction Tartaric acid rate-controlling additive facebook.com/notesdental
  • 36. Chemistry: Setting Reaction • Powder and liquid are mixed together • Acid attacks the glass particles leaching calcium, aluminium, sodium and flouride ions into the aqueous medium. • Polyacrylic acid chains - cross-linked by the Al ions • Sodium and fluorine 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 gelfacebook.com/notesdental
  • 37. Chemistry: Mechanism of Adhesion • Chelation of the carboxyl groups of the polyacrylic acids with the calcium - apatite of the enamel and dentin • Similar to polycarboxylate cement facebook.com/notesdental
  • 38. CLINICAL MANIPULATION • Surface Preparation – Pumice slurry: remove the smear layer produced by cavity preparation – Tooth may be etched for 10 sec • phosphoric acid (34% to 37%) • organic acid like polyacrylic acid (10% to 20%) – Followed by a 20- to 30-second water rinse – Dried but not desiccated – Must remain uncontaminated by saliva or blood facebook.com/notesdental
  • 39. CLINICAL MANIPULATION • Material Preparation – supplied in two bottles (powder and liquid) or capsules containing preproportioned powder and liquid – P/L ratio recommended by the manufacturer should be followed – powder should be incorporated rapidly into the liquid using a stiff spatula (AGATE) on a cool paper pad facebook.com/notesdental
  • 40. CLINICAL MANIPULATION • Normally half of the powder is mixed into the liquid for 5 to 15 seconds • rest of the powder is then quickly added • Mixed until a uniform, glossy appearance: indicates the presence of unreacted polyacid, which is critical for bonding to the tooth. facebook.com/notesdental
  • 41. CLINICAL MANIPULATION • Placement of Material – slightly overfilled with GIC restorative – Surface should be covered with a plastic matrix for about 5 minutes - protect the material from gaining or losing water during the initial set – surface must immediately be protected with the varnish supplied with the GIC or with petroleum gelly – excess GIC is removed from the margins – Finishing is improved as the cement sets facebook.com/notesdental
  • 42. PROPERTIES • Setting Time – Type I — 4-5 minutes – Type II — 7 minutes • Release of Fluoride • release fluoride in amounts comparable to those released initially from silicate cement • inhibit enamel and dentin demineralization • But its clinical efficacy is yet to be proved, where it shows anticariogenicity in vitro facebook.com/notesdental
  • 43. PROPERTIES • Greater pulpal reaction than ZOE cement but less than zinc phosphate cement • luting agents pose a greater pulpal hazard than restorative agents • Protective liner such as Ca(OH)2 should be used if the preparation is closer than 0.5 mm to the pulp chamber • Compressive strength is similar to that of zinc phosphate facebook.com/notesdental
  • 44. PROPERTIES • Modulus of elasticity is only about half that of zinc phosphate cement – less stiff and more susceptible to elastic deformation – less desirable than zinc phosphate cement to support an all-ceramic crown • greater tensile stress could develop in the crown that is supported by the GIC under occlusal loading • More vulnerable to wear than are composites facebook.com/notesdental
  • 45. Modification of GIC • Metal-reinforced GIC • High-viscosity GIC • Resin-modified GIC (hybrid ionomer) • Calcium aluminate GIC • Compomer facebook.com/notesdental
  • 46. METAL-REINFORCED GLASS IONOMER CEMENTS • Metallic fillers - improve their fracture toughness and stress-bearing capacity • Silver alloy powder or particles of silver sintered to glass • Grayish and more radiopaque • Also known as alloy admixture and cermet. • Fluoride release rate decreases over time. facebook.com/notesdental
  • 47. METAL-REINFORCED GIC : Types • Silver alloy admixed: Spherical amalgam alloy powder is mixed with type II GIC powder – Ex: Miracle Mix • Cermet: Silver particles are bonded to glass particles. – Done by sintering of a mixture of the two powders at a high temperature – Ex: Ketac Silver facebook.com/notesdental
  • 48. METAL-REINFORCED GLASS IONOMER CEMENTS • Adhesion and fluoride release – useful for core buildups of teeth – occlusal surfaces of primary molars • Compared with conventional glass ionomers or amalgam or compites – It exhibit no improvement in clinical performance and life expectancy facebook.com/notesdental
  • 49. HIGH-VISCOSITY GLASS IONOMER CEMENT • Atraumatic restorative treatment (ART) – preventive and restorative caries management – Where electricity or piped water systems is absent – hand instruments for opening tooth cavities. • GIC remains the choice of filling material in ART • Releases fluoride and bonds chemically to tooth structure • Conventional GIC was low in viscosity to flow in non-prepared carious portion of teeth • So high viscosity GIC was developed in an attempt to overcome these difficulty facebook.com/notesdental
  • 50. HIGH-VISCOSITY GLASS IONOMER CEMENT • Contain smaller glass particle sizes and use a higher P/L ratio, • Greater compressive strength • Excellent packability for better handling characteristics. • Indication – Core buildups, – Primary tooth fillings, – Non-stress-bearing restorations, – Intermediate restorations facebook.com/notesdental
  • 51. RESIN-MODIFIED GLASS IONOMER CEMENT (HYBRID IONOMER) • Water-soluble methacrylate-based monomers - replace part of liquid component of conventional GIC. • Also known as hybrid ionomer cement • Monomers can be polymerized - chemical or light activation or both. • Also contain nonreactive filler particles - lengthens the working time – improves early strength – makes the cement less sensitive to moisture during setting facebook.com/notesdental
  • 52. RESIN-MODIFIED GLASS IONOMER CEMENT (HYBRID IONOMER) • Liquid – water solution of polyacrylic acid, HEMA – polyacrylic acid modified with methacrylate • Powder: same as that for conventional GICs in addition to initiators, such as camphorquinone. • Sandwich technique: – resin-modified glass ionomer to seal the dentin – It provides the benefit of fluoride release – Over which a layer of resin composite is filled on the rest of cavity facebook.com/notesdental
  • 56. Mechanism of Bonding • Same as that for conventional GICs • Hybrid layer: cement that infiltrates the tubules, but no studies has got any conclusive evidence. • Higher bond strengths – enhanced micromechanical interlocking to the roughened tooth surface • Comparatively more microleakage – More shrinkage of hybrid ionomers – Low wettablity: lower water and carboxylic acid contents • Water resorption – by HEMA facebook.com/notesdental
  • 57. Clinical Manipulation • Indication – Liners, base materials, – Fissure sealants, – Core buildups, – Restoratives, – Adhesives for orthodontic brackets, – Repair materials for damaged amalgam cores or cusps, – Retrograde root filling materials • Surface conditioning of the tooth structure with a mild acid - bond formation facebook.com/notesdental
  • 58. CALCIUM ALUMINATE GIC • Hybrid product with a composition between that of calcium aluminate and GIC • Luting fixed prostheses • calcium aluminate component is made by sintering a mixture of high-purity Al2O3 and CaO. • Powder: calcium aluminate, polyacrylic acid, tartaric acid, strontium-fluoro-alumino-glass, and strontium fluoride • Liquid: liquid component contains 99.6% water and 0.4% additives facebook.com/notesdental
  • 59. COMPOMER • Polyacid-modified composite made by incorporating glass particles of GIC. • Water-free polyacid liquid monomer with appropriate initiator. • Properties distinctly different from those of composites and GIC • Rationale – integration of the fluoride-releasing capability of GIC – Durability of composites facebook.com/notesdental
  • 60. CHEMISTRY AND SETTING • Usually one-paste, light-cure materials - restorative applications • Powder-liquid systems: luting applications • These water free materials contain – nonreactive inorganic filler particles, – reactive silicate glass particles, – sodium fluoride, – polyacidmodified monomers: diester of 2-hydroxyl methacrylate with butane carboxylic acid and photoactivators. • Setting of one-component compomers is initiated by photopolymerization of the acidic monomer. • Sensitive to moisture facebook.com/notesdental
  • 61. CHEMISTRY AND SETTING • Functionally hydrophobic • To a lesser extent, and intraorally they absorb water from the saliva • These begins the slow acid base reaction of GIC • Powder: strontia-alumina-fluorosilicate glass, metallic oxides, and initiators (chemical/ light/ dual cure) • Liquid: polymerizable methacrylate/carboxylic monomers, multifunctional acrylate monomers and water. facebook.com/notesdental
  • 62. CLINICAL MANIPULATION • Bonding Mechanism – One-paste - require a dentin-bonding agent - do not contain water (self-adhesive) – Bond strength of one-paste compomers similar to or higher than that of hybrid ionomers. – Powder-liquid compomer: cements for luting are self-adhesive, because water in the liquid makes the mixture acidic, like hybrid ionomers. facebook.com/notesdental
  • 63. CLINICAL MANIPULATION • Restorative compomer – Low stress-bearing areas such as Class III and V prepared cavity, – Alternative to glass ionomer restoratives – Resin based composites. – Etching should be done – Finished just like resin composites. • Luting systems – Prostheses with a metallic substrate. – The cement mixture is placed only on the prosthesis - seated with finger pressure. – The margin should be light-cured immediately to stabilize the prosthesis. – The chemical-cure compomers complete their setting reaction in approximately 3 minutes in the oral environment facebook.com/notesdental
  • 64. RESIN CEMENTS • Low-viscosity versions of restorative composites. • Virtually insoluble in oral fluids. • ISO classifies resin cements according to curing mode as – class 1 (self-cured) – class 2 (light-cured) – class 3 (dual-cured) facebook.com/notesdental
  • 65. RESIN CEMENTS • APPLICATIONS – Cementation of crowns and bridges (etched cast restorations) – Cementation of porcelain veneers and inlays. – For bonding of orthodontic brackets to acid-etched enamel • Commercial Names – Panavia Ex – Infinity – Porcelite dual cure (Kerr) facebook.com/notesdental
  • 66. COMPOSITION • Powder – Resin matrix (diacrylate monomer, Bis-GMA, UDMA, TEGDMA) – Inorganic fillers – Coupling agent (organo silane) – Chemical or photo initiators and activators (Camphorquinone, a tertiary amine, Benzoyl peroxide) – tri-n-butylborane (TBB) as catalyst • Liquid – Methyl methacrylate – Tertiary amine. – 4-META, MDP facebook.com/notesdental
  • 67. CLINICAL MANIPULATION • monomeric component irritating to the pulp - pulp protection with a liner. • Chemically cured resin cements – all types of restorations – supplied as powder and liquid or two pastes, – mixed on a paper pad for 20 to 30 seconds. – slow and provides extended working time, • Dual-cure cements – mixing similar to that for the chemical-cure systems. – Curing proceeds slowly until the cement is exposed to the curing light – Should not be used in prostheses thicker than 2.5 mm facebook.com/notesdental
  • 68. CLINICAL MANIPULATION: treatment of the prosthesis • Metallic Prostheses – roughened by electrochemical etching or by grit blasting with 30- to 50-µm alumina particles at an air pressure • Polymeric Prostheses – polymer’s surface should be grit-blasted to increase the roughness for mechanical adhesion • Ceramic Prostheses – Some dental ceramic restorations are translucent – shade of luting agent must be matched. – Silica based (feldspathic porcelain): etched with hydrofluoric acid and a silane coating is applied prior to cementation, – Alumina and zirconia-based ceramics: grit blasting • Orthodontic Brackets – mechanical retention, such as the metal mesh of a metal bracket or retentive dimples or ridges on ceramic or polymer brackets facebook.com/notesdental
  • 69. ZINC OXIDE−EUGENOL CEMENT • Used for luting and intermediate restorations because of its medicament quality and neutral pH. • Cements of low strength • To improve the strength many modification have been introduced – EBA—alumina modified – Polymer—reinforced zinc oxide-eugenol cements. facebook.com/notesdental
  • 70. ZINC OXIDE−EUGENOL CEMENT • ANSI/ADA Specification No. 30 – Type I: temporary cementation; – Type II: long-term cementation of fixed prostheses; – Type III: temporary fillings and thermal insulating bases; – Type IV: intermediate fillings • Also used as a root canal sealer and periodontal dressings. facebook.com/notesdental
  • 71. ZINC OXIDE−EUGENOL CEMENT • Commercial Names – Unmodified: Tempac – Type III, Cavitic – Type IV, Temp bond – Type I – EBA alumina modified: Opotow Alumina EBA – Type II – Polymer modified: Fynal – Type II, IRM – Type III facebook.com/notesdental
  • 73. Composition • Formulated as a powder-liquid or two-paste system. • Powder or Base Paste: zinc oxide particles. • Liquid or Accelerator Paste: eugenol. • Water in the eugenol solution that hydrolyzes the zinc oxide to form zinc hydroxide. • Zinc hydroxide and eugenol chelate and solidify to form zinc oxide eugenolate. • Slow but proceeds more rapidly in a warm, humid environment. facebook.com/notesdental
  • 74. Composition • Best suited for provisional applications. • Residual free eugenol interferes with the proper setting of resin-based composites or resin cements. • Various types of carboxylic acids have been used to replace eugenol and produce a ZOE-like material. • Zinc oxide-noneugenol cements – EBA-Alumina modified cements – ZOE plus polymer facebook.com/notesdental
  • 75. Modification • EBA-ALUMINA MODIFIED CEMENTS – Liquid: substituted by orthoethoxybenzoic acid (EBA) for part of the eugenol liquid – Powder: alumina • ZOE plus polymer – Liquid: eugenol – Powder: 20% to 40%: fine polymer particles • Zinc oxide particles - surface treated with carboxylic acid • Compressive strength (CS): acceptable but their strength values are inferior to those of zinc phosphate, glass ionomer, and resin cements facebook.com/notesdental
  • 76. CLINICAL MANIPULATION • Temporary ZOE cements – luting provisional acrylic crowns and fixed partial dentures. – last a few weeks at most – seal the dentinal tubules surprisingly well against the ingress of oral fluids and have a sedative effect on the pulp – can cause pulp necrosis and should not be used directly on a pulp • Intermediate Restoration – When mixed to a stiff putty like consistency – Restorative material for at least a year. – cool glass slab slows the setting to enable the formation of a thick consistency, – not be colder than the dew point- water will condense onto the cement and accelerate the reaction • ZOE luting cements: high film thicknesses facebook.com/notesdental
  • 77. MINERAL TRIOXIDE AGGREGATE CEMENTS • A new category of cement – based on Portland cement • Good sealing ability and biocompatibility. • Contains oxides in hydraulically active ceramic compound – Calcium oxide (calcia, CaO), – Aluminum oxide (alumina, Al2O3) – Silicon dioxide (silica, SiO2) facebook.com/notesdental
  • 78. MINERAL TRIOXIDE AGGREGATE CEMENTS • Indication – Pulp capping – Apexification – Apexogenesis – Root canal sealers facebook.com/notesdental
  • 79. References • Phillips' Science of Dental Materials- Phillip Anusavice_12th • Basic Dental Materials -2nd.ed Mannapalli • Clinical Aspects of Dental Materials Theory, Practice, and Cases, 4th Edition • Craig's Restorative Dental Material 13th edition facebook.com/notesdental
  • 80. THANKS…… Like, share and comment on https://www.facebook.com/notesdental http://www.slideshare.net/DeepakKumarGupta2 www.facebook.com/notesdental