Cementation Flashcards
Steps in Delivery process
Remove the temporary
FIRST – If you did a lot of adjusting to the temporary
at the previous appointment, causing it to be more
than slightly different than the previous matrix, a
new
matrix of the temp can and should be made of the
temporary, to save you time in case you need to
remake the temp due to breakage in the process of
removing it.
Steps in Delivery process
Remove the Temporary
-Using Curved Hemostat, gently rock the
temporary back and forth to break the
cement seal.
-Care should be taken to grasp the temporary in
a manner in which the temporary is not likely
to break.
-Clean out the inside of the temporary, disinfect
it, and set it aside.
-ALWAYS make sure you have either the
temporary matrix or take a new one.
-If the temp does not come off, you may need to
gently section off the temp in order to
remove it
Remove the Temporary
Special care should be taken when
removing a
temporary on teeth with an RCT, or Post, or
Build Up.
IF the temporary does not come off easily, or
you are concerned at all about the
materials and their stability under the temp,
SECTION off the temp.
Use a very thin diamond to section Mesial-Distal
and Buccal-Lingual and then gently
remove the sections by applied lateral
force in between the criss-crossed lines you
just made.
Remove the Temporary
Once the temporary is removed:
(2)
-Clean off any excess cement chunks
-Clean the tooth preparations with
pumice slurry.
Evaluate the framework/final prosthesis
Any needs for remake or alteration
Make any adjustments prior to patient appointment
Check the prosthesis for:
-Proximal Contacts
-Internal Surface
-Marginal Adaptation
-Inter-Abutment Stability
-Occlusal Contacts
-Occlusal Anatomy and Finish
-Axial Contours
-Overall design
— the prosthetic for patient try in
Clean
Did you get what you asked for?
Check the — PRIOR to the patient coming into the office.
framework
How does your framework look?
(6)
Metal-ceramic finish lines
Framework design to support porcelain
Pontic contours
Connector location; dimension; contour
Adequate cut-back for porcelain
Adequate metal thickness in areas to be veneered
Steps in Delivery Process –
Prior to patient appointment
With a Metal Ceramic framework, or a Zirconia based
framework, often, trying in the framework is necessary to
ensure the
fit prior to porcelain veneering.
Framework is tried in to check:
(5)
-Proximal contacts
-Internal fit
-Marginal integrity
-Stability (any distortion?)
-Occlusion
At this appointment, — is also confirmed.
shade selection
Once Ceramic is veneered, at try in check:
(3)
-Same checklist as above
-Any adjustments needed like occlusion or contacts
-Patient approval and acceptance and consent for
cementation
Does the framework wobble or rock on the preparations?
(3)
-Check the Proximal contacts
-Evaluate visually and with floss or shimstock
-Mark areas and adjust as needed if contact is
inhibiting full seat.
Check internal surface
(3)
-Use “Fit Checker” or similar to check internal
surface.
-Adjust any ”positive” areas
-Only minor adjustments should be made in the
internal surface.
Check the margin adaptation of the framework
(2)
-A “positive” defect means there is too much
framework material, and this can be polished
away with a stone or rubber wheel to see if this
allows the rock to disappear
-A “negative” defect means you have an open
margin and a new impression will need to be
taken.
Try in the framework
-Does the framework rock still?
-If the Contacts are appropriate
-If the Internal surface is not hindering seat
-Then the — may be distorted.
Framework
Then the Framework may be distorted.
(4)
-Section the framework through a connector
-Evaluate each retainer separately
-If individually, each retainer fits, move forward with
solder technique
-If individually, either retainer still wobbles or rocks,
take a new impression
Framework is sectioned
Cut should be:
(3)
-At least 0.2mm wide
-Flat
-Have parallel sides
Making sure individual retainers are
solidly
placed and stationary, make Duralay
relation.
Once Duralay has set, evaluate
framework to make sure
rocking or
wobble has been removed.
Make a plaster “pick up” index after
Duralay is set to
stabilize the
framework as you send it to the lab.
Once framework returns from soldering at the
laboratory:
Evaluate all aspects of the framework again
(5)
-Proximal contacts
-Internal fit
-Marginal integrity
-Stability (any distortion?)
-Occlusion
-Occlusion
(2)
-Is occlusion in the mouth the same as on the
casts?
If not, take a bite registration with and remount the
casts.
Take a Pre-Veneering Radiograph to confirm —
Margins
Take a — and send back to the lab for porcelain
veneering.
shade
Steps in Delivery Process – Lab Script
Phase 1
-”Please pour impression; pin and section cast; articulate master
cast with enclosed opposing using interocclusal record. Return for die
trimming and evaluation of articulation.
Phase 2
-”Please fabricate metal-ceramic framework using noble alloy as
follows:
-#3 full cast retainer
-#4 Modified Ridge Lap pontic
-Porcelain finish line half way down lingual incline of
lingual cusp
-#5 Facial porcelain shoulder margin
-mesial and occlusal contacts in porcelain
-porcelain-metal finish line half way down lingual surface
extending proximally to support porcelain
Occlusion:
Occlusion:
establish centric contacts in MIP; no lateral or
protrusive excursive movements
Return in one piece for framework try-in
Phase 3
-Please add porcelain to complete FPD
according to above specifications
Steps in Delivery Process – Final product
Framework returns with porcelain veneering for final
seating.
Remove the temp, clean and prepare teeth for
seating by making sure
all temporary cement is
removed and tooth has been pumiced.
Try in framework and follow previously stated
guidelines to check for marginal adaptation, pontic
adequacy, and any rock or wobble.
***Take a Pre-Cement Radiograph to confirm
Margins
If needed, using a — (seen in
photos to the right) can help you determine if any
part of the prep or intaglio surface needs to be
adjusted to enable full seating of bridge.
product like Fit Checker
Now that porcelain has been applied, re-evaluate
the bridge for stablility, proximal contacts, and
marginal integrity.
What would you do about this situation?
Look for passive contact with tissue. Slight
blanching of tissue acceptable. More than this,
adjust pontic/tissue contact. If adjustment is
made, this tissue portion needs to be HIGHLY
polished.
When bridge fully seats, has floss contact, and pontic fit is
acceptable, next is occlusion.
Check occlusion in (3) movements.
Anterior bridges need to have appropriate length in
protrusive to protect against porcelain —.
— guidance should be maintained.
MI, lateral, and protrusive
chipping
Canine
Evaluation of Esthetics:
Look at the angulation of the
facial
-Do the pontics line up with the rest of
the neighboring teeth?
Step back and view the patient from several
feet away.
(3)
-Is the appearance harmonious?
-Is there anything else you could do to make
it more esthetic?
-Does the patient approve of the esthetics?
If you as the dentist are happy with the fit
and esthetics, THEN
show the patient.
Their approval (often as a signed
consent) is necessary prior to
cementation.
Polishing and Finishing
Did you adjust the metal or porcelain?
(3)
-Contacts?
-Occlusion?
-Pontic shape?
Final step prior to cementation is
polishing/finishing.
Final step prior to cementation is polishing/finishing.
-Metal adjustments can be polished like
Gold. Brown and
Green polishers work very well. Brown is Course and
Green is fine. Two step polishing.
Try to stay away from polishing at the —
with these burrs. The colors can stay in the porcelain and contamination the porcelain porosities. It’ll look ugly!!
ceramic metal junction
If it is necessary to smooth or polish at the Metal-Ceramic
junction:
-the burr/stone should be held perpendicular to the junction
otherwise, the metal particles contaminate the
porcelain decreasing the esthetics.
Polishing Porcelain:
(2)
-Margin adjustment should be made
perpendicular to the margin and rotation of
polisher should be toward bulk of material.
-Easiest to polish prior to cementation
Adjusting Ceramic
-Use — forces when inserting and
testing the fit of Bridge
-Do not overheat/create excess
vibration. This leads to —
-Use fine diamonds
-Use separate instruments for metal and
porcelain.
-Polish porcelain with diamond rubber
points and then a fine diamond
impregnated polishing paste
gentle
microcracks and tends toward fracture
Important to keep the
— as much as possible
while adjusting the metal or
porcelain.
Its too easy to grind away the
high spots, polish them down,
and insert.
This leads to poor — in
other areas and can cause
occlusal disharmony.
anatomy
occlusion
Conventional Cements aka Luting Cements
(5)
-Zinc-oxide Eugenol (temporary cement) Temp Bond
-Zinc Polycarboxylate (temporary cement) Durelon
-Zinc Phosphate cement Gold Standard all cements are
compared to
-Glass ionomer cement
-Resin Modified Glass Ionomer *** Most commonly used
currently Rely-X Luting
What does luting mean?
The word ‘luting’ implies the
use of a moldable substance to seal a space or to
cement two components together (Anusavice, Shen,
& Rawls 2003).
Luting Cement Characteristics:
Advantages:
(6)
-Adhesion to tooth substance and alloys
-Easy manipulation
-Strength
-Solubility
-Film Thickness properties comparable to Zinc Phosphate
-Fluoride release
Luting Cement Characteristics:
Disadvantages:
(6)
-Needs accurate proportioning
-Critical manipulation
-Lower Compressive strength
-Greater viscoelasticity than Zinc Phosphate
-Short working time
-Clean surfaces needed for best adhesion
Resin based Cements aka Adhesive Cements
(4)
-Adhesive Resin Cement with Dentin Bonding Agent
-Self-Etch
-Self- Adhesive
*** Self-Etch and Self-Adhesive resin cements bond to the tooth. (SpeedCem Plus)
-Adhesive Resin Cement with Dentin Bonding Agent
-Total or Selective Etch
-Self-Etch
-Self etching primer with no extra Dentin Bonding
Agent
-Self- Adhesive
-No etch, no primer, no Dentin Bonding Agent
Resin based Cement Characteristics
Advantages
(3)
-High Strength
-Low oral solubility
-high micromechanical bonding to dentin, alloys
and ceramic surfaces
Resin based Cement Characteristics
Disadvantages:
(6)
-Need for meticulous and critical technique
-More difficult sealing
-Higher film thickness
-Possible leakage
-Pulpal Sensitivity
-Difficulty in removal of excess cement.
Resin based Cement Characteristics
Adhesive Resin Cement
-Requires use of
-Dentin Bonding Agent bonds to — and Resin
Cement bonds to
-Most – cement system
-Most –
-Used for – restorations mostly
Dentin Bonding Agent
tooth, Dentin Bonding Agent
esthetic
retentive
Veneer
Resin based Cement Characteristics
Self-Adhesive Resin Cements
-Self-Etch Adhesive Resin Cement
-Self-Adhesive Resin Cement
-Resin Cement interacts
-Generally creates
does not require a separate Dentin
Bonding Agent but requires tooth pre-treatment in the form of a
“Primer”.
requires no Dentin Bonding Agent nor does it
require a Self-Etch Primer pre-treatment.
directly with the tooth surface
higher bonds to dentin.
Resin Cements require a — free environment
moisture
-A Resin Cement is required for
low-strength glass ceramics (Veneers)
Resin Modified Glass Ionomer cements are contra-indicated with
low-
strength glass ceramics
-These RMGI cements absorb water and expand as they set which could
cause fracture of ceramics especially at the margins
RMGI cements need an adequate
retentive preparation
RMGI is great with (3)
metal, PFM, and Zirconia restorations.
Resin Cements are recommended for — crowns to offset the brittle nature of glass
ceramic.
eMax
RMGI cement is typically only used with IPS e.max when tooth preparations are
sufficiently deep
axially and with margin thickness of at least 1mm.
and retentive mechanically, and patients are highly caries-prone (geriatric, pediatric, etc.).
Type of Material
(4)
Metal, PFM, Zirconia, Ceramic
Design of material
(4)
Veneer, Crown, Inlay/Onlay, Bridge
Tooth Preparation and location
(2)
Retentive prep, Non-Retentive prep,
Additional Factors
(4)
-High Caries prone patient?
-Wacky Occlusion?
-Moisture Isolation a problem?
-Clencher or Grinder
PFM Cementation
-With adequate preparation retentive features
(3) can be used
-**— is most commonly used
Zinc Phosphate, Glass Ionomer, or Resin
Modified Glass Ionomer cement
RMGI
Without totally adequate preparation retentive
features, wonky occlusion, or bruxer, – should be considered due to its
increased strength.
-With a PFM, Resin Cement that is (2) is a must.
Resin
Cement
Dual
Cure or Self Cure
Glass Ceramic Cementation
Due to strength of Glass Ceramics,
Resin Cement is the
cement of choice.
-Prefer Dual Cure or Self Cure
Restoration pre-cementation treatment
-Internal Surface –
-Typically this is done by the lab.
Hydrofluoric Acid Etch to roughen for
micromechanical retention for e.Max or Feldspathic
porcelain
-***Sandblasting or diamond bur roughening would
damage the surface of these ceramics
-Silane treatment in internal surface to enhance the
chemical bond between glass/ceramic/Resin
Cement
Zirconia Cementation
-With adequate preparation retentive features (3)can be used
**— is most commonly used
Zinc Phosphate, Glass
Ionomer, or Resin Modified Glass Ionomer cement
RMGI
Zirconia Cementation
Without totally adequate preparation retentive features, wonky
occlusion, or bruxer — Cement should be considered due to its
increased strength.
Resin
Zirconia Cementation
Internal Surface Pre-Treatment
(2)
-Abrasion needed. Lab leaves internal too smooth.
-Air abrasion or diamond Bur leaving horizontal roughened
lines on internal walls
Zirconia Cementation
Adhesive promoting agent can be used but must contain
MDP!
-methacryloyloxydecyl dihydrogen phosphate.
Eugenol from some temporary cements will prohibit
polymerization of
any composite Resin.
Acid etchant removes the — residue.
eugenol
Provisional cement residue occludes tubules and decreases
effective
bonding.
Cleaning the tooth with – removes the temporary cement
residue.
pumice
Remember:
-Follow the specific instructions for the cement you are using
-Patient should close down on
soft cotton roll to help with seating of crown.
DO NOT USE ANYTHING HARD FOR THIS STEP – Leads to fracturing
-If occlusion does not permit solid pressure for crown seating, firm pressure
from finger is used to fully seat crown until cement has cured on its own,
or it has been light cured.
When using a curing light for a Resin Cement, seat the crown full
of cement, and “—” the cement
(2)
Tack
-Turn on your curing light while on the facial margin and
IMMEDIATELY turn it off. Place the curing light on the lingual
and turn it on and IMMEDIATELY turn it off.
-This allows you to partially cure the cement so it peels away
If you cure fully with too much excess, it will be very challenging
to be able to
remove all the cement. You’ll need high
speed handpieces and a whole lot of luck.
-Once excess is removed with hand instruments, floss to remove
interproximal excess. Once all cleaned, fully cure on facial,
lingual, and move light around to cure the interproximal
areas too.
Now that your prosthesis is cemented:
-Recheck —
-Adjust if necessary
-Use a fine Diamond with water to avoid excess —
-Polish with —
***Take a Post-Cementation —
-Discuss — with patient
occlusion
heat
diamond impregnated discs or points
Radiograph
OHI
