Dental Cements PPT

DENTAL CEMENTSDENTAL CEMENTSfor Luting and Bondingfor Luting and Bonding

2004, Bayne and Thompson, UNC School of Dentistry.

Stephen C. BayneStephen C. BayneOperative DentistryOperative Dentistry

UNC School of DentistryUNC School of DentistryChapel Hill, NC 27599Chapel Hill, NC 27599--74507450

RETENTION BY DENTAL CEMENTSRETENTION BY DENTAL CEMENTSCoarse and fine micromechanical retentionCoarse and fine micromechanical retention

DENTIN

DENTAL JOINTSDENTAL JOINTS

ENAMEL, DENTIN >ENAMEL, DENTIN >Liner, Base, Cement >Liner, Base, Cement >

Post and Core >Post and Core >Dental Amalgam >Dental Amalgam >

Implant >Implant >

< Composite, Amalgam< Composite, Amalgam< Cast Inlay, Onlay, or Crown< Cast Inlay, Onlay, or Crown< All< All--ceramic Inlay, Onlay, or Crownceramic Inlay, Onlay, or Crown< Veneers, Maryland Bridges< Veneers, Maryland Bridges< Orthodontic Brackets< Orthodontic Brackets

AdherendAdherend AdherendAdherend

ADHESIVE SYSTEMADHESIVE SYSTEMor or LUTING CEMENTLUTING CEMENT

CrownCrown

ToothToothStructureStructure

??????MicroleakageMicroleakage

FluidFluidFlowFlow

GOALS:GOALS:•• Retention / resistance formRetention / resistance form•• Sealing (No fluid flow or ML)Sealing (No fluid flow or ML)

CEMENT FACTS:CEMENT FACTS:•• No correlation of lab and clinical performance.No correlation of lab and clinical performance.•• RMGI for metal substructures and composite for ceramics.RMGI for metal substructures and composite for ceramics.•• Failure occurs by fatigue Failure occurs by fatigue –– crack formation and propagation.crack formation and propagation.•• Compositions and properties constantly changing.Compositions and properties constantly changing.•• Cements are theoretically strong enough.Cements are theoretically strong enough.•• Initial effectiveness requires “retention and sealing.”Initial effectiveness requires “retention and sealing.”•• Cement more stable at enamel rather than dentin margins.Cement more stable at enamel rather than dentin margins.•• Highest stress in cements occurs at margins.Highest stress in cements occurs at margins.

Ceramic POWDER ParticlesCeramic POWDER Particles(BASIC)(BASIC)

Inorganic or organic LIQUIDInorganic or organic LIQUID(ACIDIC)(ACIDIC)

CEMENT MICROSTRUCTURECEMENT MICROSTRUCTURE

Residual POWDER ParticlesResidual POWDER Particles(FILLER)(FILLER)

AcidAcid--Base SaltBase Salt(REACTION PRODUCT)(REACTION PRODUCT)

Powder reinforces set cement matrixPowder reinforces set cement matrixZinc Phosphate CementZinc Phosphate Cement

Zinc Oxide EugenolZinc Oxide Eugenol::ZOEZOE (ZOE)(ZOE) EugenolEugenol ZnOZnOReinforced ZOEReinforced ZOE (RZOE)(RZOE) EugenolEugenol ZnO, Polymer, RosinZnO, Polymer, RosinZOEZOE--EBAEBA (EBA)(EBA) Eug, EBAEug, EBA ZnO, AlZnO, Al22OO33, Rosin, RosinHVHV--EBAEBA (HV(HV--EBA)EBA) HV, EugHV, Eug ZnO, AlZnO, Al22OO33, Rosin, Rosin

OVERVIEW OF DENTAL CEMENTSOVERVIEW OF DENTAL CEMENTS

Zinc PhosphateZinc Phosphate (ZP)(ZP) HH33POPO44 / H/ H22OO ZnOZnOSilicateSilicate (SC)(SC) HH33POPO44 / H/ H22OO FF--AlAl--Silicate glassSilicate glassZinc SilicophosphateZinc Silicophosphate (ZSP)(ZSP) HH33POPO44 / H/ H22OO ZnO, FZnO, F--AlAl--SilicateSilicate

Cement Type:Cement Type: (Abbr.)(Abbr.) LIQUIDLIQUID POWDERPOWDER

PolycarboxylatePolycarboxylate (PC)(PC) PAA / HPAA / H22OO ZnOZnOGlass IonomerGlass Ionomer::

ConventionalConventional (GI)(GI) PAA / HPAA / H22OO FF--AlAl--Silicate GlassSilicate GlassResinResin--ModifiedModified (RMGI)(RMGI) “ + HEMA, …“ + HEMA, … FF--AlAl--Silicate GlassSilicate GlassCompomerCompomer (CM)(CM) (Monomers)(Monomers) FF--AlAl--Silicate GlassSilicate Glass

CompositeComposite (with DBS)(with DBS) (CC, CP)(CC, CP) (Monomers)(Monomers) (Silicate glass fillers)(Silicate glass fillers)

Contemporary Practice

Dental Cement TimelineDental Cement Timeline1850 1900 2000

ZOEZP SC

PCC

GI

CC

RMGICompomer

1950

Generations of CementsGenerations of Cements

Zinc Phosphate Polycarboxylate Glass Ionomer

Resin-Modified Glass Ionomer Composite Cement

What do you use ???What do you use ???

, Compomer

3M-ESPE RelyX UNICEM

MultiLink

IVOCLAR / VIVADENT

2001---10%

5%75 %10%

Clinical Research Associates. Clinical Research Associates. Materials use survey.Materials use survey.CRA Newsletter. CRA Newsletter. 1990;14(12):1; 1995;19(10):31990;14(12):1; 1995;19(10):3--4; 2001…4; 2001…

Dental Cement Use• EBA (ZOE)• Zinc Phosphate• Polycarboxylate• GI• Resin (Composite)

19901%

22%33%42%

2%, RMGI

1995---12%17%65%

6%

100

50

75

0.1

25

1.0 100010010 (hrs)

TIME

% C

ON

VER

SIO

N

50

25

TIME

% C

ON

VER

SIO

N

PassesLarge Indentor

PassesSmall Indentor

MixingTime Working

Time SettingTime

MixingInterval

WorkingInterval

SettingInterval

InitialSet

FinalSet

InitialSet

FinalSet

SETTING REACTIONSSETTING REACTIONS

DENTAL CEMENT PROPERTIESDENTAL CEMENT PROPERTIES

BIOLOGICAL PROPERTIES:BIOLOGICAL PROPERTIES:---- Chemical Irritation of Pulp During SettingChemical Irritation of Pulp During Setting

MECHANICAL PROPERTIES:MECHANICAL PROPERTIES:---- Compressive StrengthCompressive Strength---- Tensile StrengthTensile Strength---- Shear StrengthShear Strength---- Bond StrengthBond Strength

PHYSICAL PROPERTIES:-- Coefficient of Thermal Expansion-- Thermal Conductivity

CROWNCROWN

TOOTHTOOTHSTRUCTURESTRUCTURE

CHEMICAL PROPERTIES:CHEMICAL PROPERTIES:---- Solubility and DisintegrationSolubility and Disintegration---- AbsorptionAbsorption

DENTAL CEMENT PROPERTIESDENTAL CEMENT PROPERTIES

Physical Physical Chemical Chemical MechanicalMechanicalPropertiesProperties PropertiesProperties PropertiesProperties________

SettingSetting SolubilitySolubility CSCS∆∆l (l (µµm/cm)m/cm) (w/o, 37°C, 7d)(w/o, 37°C, 7d) (psi, 37°C, 7d)(psi, 37°C, 7d)

ZOEZOE --31 to 31 to --8585 0.02 to 0.100.02 to 0.10 2000 to 55002000 to 5500RR--ZOEZOE -------- to to -------- -------- to to -------- 10000 to 1500010000 to 15000ZOEZOE--EBAEBA --12 to 12 to --2424 -------- to 0.40to 0.40 ---------------- to to ----------------HVHV--EBAEBA -------- to to -------- -------- to 0.01to 0.01 ---------------- to to ----------------ZPZP +15 to +15 to --77 0.05 to 0.100.05 to 0.10 19000 to 2100019000 to 21000PCPC +50 to +420+50 to +420 0.04 to 0.08 0.04 to 0.08 8000 to 180008000 to 18000GIGI ?????? ?????? 18000 to 2400018000 to 24000RMGIRMGI ?????? ?????? 24000 to 3000024000 to 30000CompositeComposite ?????? ?????? 35000 to 4500035000 to 45000

??????

SilveySilvey RG, Myers GE.RG, Myers GE.Clinical study of dental cements. VII. A study of bridge Clinical study of dental cements. VII. A study of bridge retainers luted with three different dental cements.retainers luted with three different dental cements.J Dent J Dent ResRes 1978;57:7031978;57:703--707.707.

In a clinical study of three luting cements, 547 bridges and 162 crowns were permanently cemented. Patients were recalled at 6-month intervals and the restorations were examined for looseness. A pattern of retainer type, cement type and retainer success was demonstrable.

5-Year Cement Retention: Crowns BridgesReinforced ZOE, ZOE-EBA 98% 92%Zinc Phosphate 100% 98%Polycarboxylate 96% 95%

Zn(OH)2Mg(OH)2Zn(PO4)2

H2O, Lactic acidNa+, Cl-

F-

Ca+, K+

CEMENT AGINGCEMENT AGINGSOLUBILITY and DISINTEGRATIONSOLUBILITY and DISINTEGRATION

ZINCZINCPHOSPHATEPHOSPHATE

CEMENTCEMENT

ADAADATestTest

ZnO (and MgO),Tertiary ZP Crystals

MultifactorialSolubility and Disintegration

Events

CementCementWaterWater

CROWNCROWN

TOOTHTOOTHSTRUCTURESTRUCTURE

??????

CEMENT THICKNESS:CEMENT THICKNESS:

•• 110 µm110 µm is average and 50is average and 50--350 350 is typical.is typical.•• ≤≤100 100 µµmm is generally considered ideal.is generally considered ideal.

0

10

20

100

90

80

70

60

50

40

30

CEM

ENT

THIC

KN

ESS

(100

µm

)

TOOTHTOOTH

CROWNCROWN

PowderPowderParticleParticleErosionErosion

CRACKCRACK

New PhaseNew PhasePrecipitationPrecipitation

LARGELARGEPOREPORE

RETENTION?RETENTION?SEALING?SEALING?

y = 100e-0.0598x

R2 = 0.9101

0

20

40

60

80

100

0 20 40 60 80 100

POROSITY (%)

REL

ATI

VE S

TREN

GTH

(%)

Ryskewitsch. J Am Ceram Soc 1953;36:65. (Empirical suggestion σ =σoexp(-nP) where n=4-7 and P=volume fraction porosity.)

Compressive Strength (MPa)Compressive Strength (MPa)

Freq

uenc

y (n

)Fr

eque

ncy

(n)

40 50 60 70 80 90

1

2

3

4

5

MEDIANMEDIAN

CEMENT MANIPULATIONCEMENT MANIPULATION“20 different experienced dental assistants mixing the same ceme“20 different experienced dental assistants mixing the same cement”nt”

Success / Failure Factors:Success / Failure Factors:(1) Operator(1) Operator(2) Design Factors(2) Design Factors(3) Materials Factors(3) Materials Factors(4) Intraoral Location Factors(4) Intraoral Location Factors(5) Patient Factors(5) Patient Factors

ZnO

Eug+

EBA

ZnO + OCH3

CH2-CH=CH2

HO

(Eugenol)

OCH2-H3

COOH(EBA)

ZnO

HO

H3CO

CH2-CH=CH2

HO

OCH3

CH2=CH-CH2

Zn+2

-O

OCH2CH3

C-OH

O- Zn+2

H3CH2CO

HO-C

(ZincEthoxyBemzoate)

(ZincEugenolate)

ZOEZOE--EBAEBATraditional Ceramic Dental CementTraditional Ceramic Dental Cement

ZnO

H3PO4in

H2OZnO

ZINC PHOSPHATE CEMENTZINC PHOSPHATE CEMENTSetting ReactionSetting Reaction

Zn3(PO4)2- 4H2O(tertiary zinc phosphate)

ZnO + 2H3PO4 + H2OZn(H2PO4)2- nH2O

Zn(H2PO4)2-H2O on mixing

Cautions:Cautions:Do not use on RDT < 1.0 mmDo not use on RDT < 1.0 mm

Mixing Procedure and PrecautionsMixing Procedure and PrecautionsZinc Phosphate Cement

Chilled glass slaband dispensing P.

Dividing P portionsand dispensing L.

Incremental additionsand stropping.

Fleck’sFleck’sMizzyMizzy

ZP CementZP Cement

Mixing,Mixing,Working,Working,SettingSettingIntervalsIntervals

CEMENT ACIDITY ON SETTINGCEMENT ACIDITY ON SETTINGZinc Phosphate Cement

0 10 100 1,000 10,000

TIME (minutes)TIME (minutes)

765

1234

pH

1 day 1 week1 hrMix

SiO2,Al2O3,Na, Ca, F

H3PO4in

H2OSiO2,Al2O3,Na, Ca, F

Si+4

Al+3

Na+

Ca+2

F-

PO4-3


Residual Glass ParticleAlumino-silico-phosphate GLASS

Si+4, Al+3, Ca+2, Na+, F- Ions

SILICATE CEMENTSILICATE CEMENTSilicoSilico--phosphate = Traditional Ceramic Filling Materialphosphate = Traditional Ceramic Filling Material

Residual Glass ParticleZINC POLYACRYLATE GEL

ZnO

ZnO

PAAin

H2O ZnO

-- COO-

-- COO-

-- COO-

HOOC --

-OOC -- -OOC ---- COO-

-- COOH

-OOC --

-OOC --

-- COOH

Zn+2

Zn+2

Zn+2

POLYCARBOXYLATE CEMENTPOLYCARBOXYLATE CEMENTPolymerPolymer--Based Dental CementBased Dental Cement

Mixing Procedure and PrecautionsMixing Procedure and PrecautionsPolycarboxylate Cement

DispensingP and L.

Stropping.

Folding Pinto L.

A

B

C

D

E


Si+4

Al+3

Na+

Ca+2

F-

PAA


PAAin

H2O


Residual Glass ParticlePOLYACRYLATE GEL(initially Ca polyacrylate geland later Al polyacrylate gel)

Si+4, Al+3, Ca+2, Na+, F- Ions

GLASS IONOMER CEMENTGLASS IONOMER CEMENTHybrid = SC(P) and PCC(L), PolymerHybrid = SC(P) and PCC(L), Polymer--Based Dental CementBased Dental Cement

COOCOO¯̄

COOCOO¯̄

¯̄OOCOOC

COOCOO¯̄

COOCOO¯̄

COOCOO¯̄

COOCOO¯̄

¯̄OOCOOC

¯̄OOCOOC

¯̄OOCOOC

¯̄OOCOOC

Al+3Al+3

----OO--Si+4(OH)Si+4(OH)22

Ca++Ca++

Ca+Ca+

Ca+Ca+¯̄OOCOOC

¯̄OOCOOC

COOCOO¯̄¯̄OOCOOC

COOCOO¯̄

FF--AlAl--SiOSiO2,2,

CaFCaF22

HH--OO--HH

HH--OO--HH

HH--OO--HH

HH--OO--HH

HH--OO--HH

GLASS IONOMER CEMENTGLASS IONOMER CEMENTReactionsReactions

CaCa+2+2 AlAl+3+3

SiSi+4+4FF--

UniversalUniversalCEMENTSCEMENTS

GICGIC

COMPOSITECOMPOSITE

HYDROGELHYDROGEL

Hydrophobic POLYMERHydrophobic POLYMER

RMRM--GICGIC§GIC and§VLC Hydrophilic

monomer and polymer

CEMENTSCEMENTS

MMMM--GICGIC§GIC and§Metallic fillers§Cermet fillers

CORESCORES

COMPOMERCOMPOMER§ VLC Composite and§ F source

FILLING MATERIALSFILLING MATERIALS

RRRR--GICGIC§GIC and§Resin-Fillers

A.R.T. andA.R.T. andTEMPORARIESTEMPORARIES

GIOMERGIOMER§ VLC Composite and§ Pre-reacted GIC powder


CEMENTSCEMENTS


FluoroFluoro--AluminoAlumino--SilicateSilicateParticleParticle

CementCementMatrixMatrix

Dissolution of particleedge for reaction.

Slow long-term F-ionrelease by diffusionfrom particle.

SLOWSLOW FF--11

FF--11,, CaCa+2+2,,AlAl+3+3,, SiSi+4+4

Rapid earlyF-ion releasefrom matrix.

FASTFAST

2020

1010

1515

55

1414 2121 28287700TIME (Days)TIME (Days)

FLU

OR

IDE

REL

EASE

(ppm

)FL

UO

RID

E R

ELEA

SE (p

pm)

PARTICLESPARTICLES

MAT

RIX

MAT

RIX

EFFECTIVE LEVELSEFFECTIVE LEVELS

2020

1010

1515

55

1414 2121 28287700TIME (Days)TIME (Days)

FLU

OR

IDE

REL

EASE

(ppm

)FL

UO

RID

E R

ELEA

SE (p

pm)

RECHARGING:RECHARGING:•• Fluoride Toothpaste,Fluoride Toothpaste,•• Topical Fluoride,Topical Fluoride,•• Fluoride MouthrinseFluoride Mouthrinse

PARTICLESPARTICLES

MAT

RIX

MAT

RIX

ENAMELENAMELCERAMICCERAMICINLAYINLAY

AcidAcid--etchedetchedenamel enamel and dentinand dentin

DentinDentinbondingbondingsystemsystem

Silanated / Bonded Silanated / Bonded surfacesurface

HF acidHF acid--etchedetchedsurfacesurface

RESININLAY

CEMENT

CERAMIC BONDINGCERAMIC BONDING

Resin CementResin Cement= Composite= Composite

HF ETCHINGHF ETCHING•• HighHigh--Leucite PorcelainsLeucite Porcelains•• HighHigh--Alumina PorcelainsAlumina Porcelains•• Alumina Cores (ProCera)Alumina Cores (ProCera)•• Zirconia Cores (Cercon, Lava)Zirconia Cores (Cercon, Lava)

DENTINDENTIN

DENTAL CEMENT EXAMPLESDENTAL CEMENT EXAMPLESA.A. Zinc Oxide Eugenol CementsZinc Oxide Eugenol Cements::

ZOE 2200 (LD Caulk)ZOE 2200 (LD Caulk)

ZOE (J. Bird Moyer Co.)ZOE (J. Bird Moyer Co.)

ZOE Temporary (LD Caulk)ZOE Temporary (LD Caulk)ZOGENOL (Stratford ZOGENOL (Stratford CooksonCookson))Reinforced ZOE Cements (RZOE):Reinforced ZOE Cements (RZOE):ZOE B+T (LD Caulk)ZOE B+T (LD Caulk)IRM (LD Caulk)IRM (LD Caulk)FYNAL (LD Caulk)FYNAL (LD Caulk)ZEBACEM (LD Caulk)ZEBACEM (LD Caulk)OPOTOW ALUMINAOPOTOW ALUMINA--EBA (Getz)EBA (Getz)AURACEM (DMG Hamburg)AURACEM (DMG Hamburg)

B.B. HexylHexyl VanillateVanillate Cements (HV):Cements (HV):(None currently marketed)(None currently marketed)

C.C. Zinc Phosphate Cements (ZP):Zinc Phosphate Cements (ZP):MODERN TENACIN (LD Caulk)MODERN TENACIN (LD Caulk)FLECK'S EXTRAORDINARY (FLECK'S EXTRAORDINARY (MizzyMizzy))SMITH'S ZINC CEMENT (Teledyne)SMITH'S ZINC CEMENT (Teledyne)AMES ZAMES Z--M (Teledyne)M (Teledyne)KENT ZINC CEMENT (Stratford KENT ZINC CEMENT (Stratford CooksonCookson))LANGLANG--C+B Only (Lang)C+B Only (Lang)SS--C (Stratford C (Stratford CooksonCookson))DROPSIN (Atwood Industries)DROPSIN (Atwood Industries)ELITE (I.D.T. Corp)ELITE (I.D.T. Corp)

D.D. Silicate Cements (SC):Silicate Cements (SC):

E.E. Zinc Zinc SilicoSilico--phosphate Cements (ZSP):phosphate Cements (ZSP):AMES PLASTIC Porcelain (Teledyne)AMES PLASTIC Porcelain (Teledyne)ASTRALITASTRALIT (Premier)(Premier)SYNTREX F (Premier)SYNTREX F (Premier)SILICAP (HD SILICAP (HD JustiJusti))

F.F. Polycarboxylate Cements (PC):Polycarboxylate Cements (PC):TYLOK (LD Caulk)TYLOK (LD Caulk)DURELONDURELON (Premier)(Premier)CHEMIT (Harry J. Bosworth)CHEMIT (Harry J. Bosworth)CARBOXYLON (3M)CARBOXYLON (3M)POLYPOLY--F (F (DeTreyDeTrey))

G.G. Glass Ionomer (GI):Glass Ionomer (GI):ASPA (LD Caulk)ASPA (LD Caulk)IONOMER (IONOMER (DenmatDenmat))FUJI II (GC America)FUJI II (GC America)KETACKETAC--CEM (ESPE))CEM (ESPE))BIOBOND LUTING (Harry J. Bosworth)BIOBOND LUTING (Harry J. Bosworth)AQUACEM (AQUACEM (DeTreyDeTrey))BASELINE (BASELINE (DeTreyDeTrey))

ResinResin--ModifedModifed Glass Ionomer (RMGI):Glass Ionomer (RMGI):FUJI I (GC)FUJI I (GC)FUJI PLUS (GCFUJI PLUS (GC--America)America)RELYRELY--X LUTING (VITREMER CEMENT) (3M)X LUTING (VITREMER CEMENT) (3M)ADVANCE (LD Caulk)ADVANCE (LD Caulk)PRINCIPLEPRINCIPLE (LD Caulk)(LD Caulk)NEXUS (Kerr)NEXUS (Kerr)DYRACT CEM (Dentsply)DYRACT CEM (Dentsply)PERMACEM (DMG Hamburg)PERMACEM (DMG Hamburg)VITREBOND CEMENT (3M)VITREBOND CEMENT (3M)

Compomer Compomer UniCemUniCem (3M(3M--ESPE)ESPE)MaxCemMaxCem (Kerr)(Kerr)MultiLinkMultiLink ((HeraeusHeraeus--KulzerKulzer))

H.H. (Resin) Composite Cements (CC):(Resin) Composite Cements (CC):COMSPAN (LD Caulk)COMSPAN (LD Caulk)PANAVIA F (Kuraray)PANAVIA F (Kuraray)PANAVIA 21 (Kuraray)PANAVIA 21 (Kuraray)ENFORCE (LD Caulk)ENFORCE (LD Caulk)RESIN CEMENT (3M)RESIN CEMENT (3M)NEXUS (Kerr)NEXUS (Kerr)MEGABOND (Harry J. Bosworth)MEGABOND (Harry J. Bosworth)DUODUO--CEMENT (CEMENT (ColteneColtene))CALIBRA (LD Caulk)CALIBRA (LD Caulk)OPAL LUTING (3M)OPAL LUTING (3M)COMPOLUTE (ESPE)COMPOLUTE (ESPE)CEMENTCEMENT--IT (IT (Jeneric/PentronJeneric/Pentron))LUTELUTE--IT (IT (Jeneric/PentronJeneric/Pentron))BUILDBUILD--IT (IT (Jeneric/PentronJeneric/Pentron))

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Dental Cements PPT

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