Cementation Flashcards by Naina K

Layers of tooth

Dentine
Enamel
Restoration - Cement
Restoration (metal, ceramic, composite resin)

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Most commonly used

Composite resin

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Procedure
Metal and metal ceramic restorations
Metal and ceramic endodontic posts
All-ceramic reinforced core ceramics

Resin bonded bridges

Precious metal bonding e.g intra-oral repair

Resin-bonded ceramics

Composite restorations
Fibre reinforced resin bridges
Fibre reinforced endodontic posts

Conventional cementation - non adhesive

Etching
Gritblasting

Tin plating
Silica coating
Metal primers

HF etch + silane

Resin to resin bond

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Luting agents for:

Metal and metal ceramic restorations

Metal and ceramic endodontic posts
All-ceramic reinforced core ceramics

Resin bonded bridges

Precious metal bonding e.g intra-oral repair

Resin-bonded ceramics

Composite restorations
Fibre reinforced resin bridges
Fibre reinforced endodontic posts

Zinc phosphate cement
Zinc polycarboxylate cement

GIC, RMGICs, Compomers

Dark cure resins
Adhesive resins

Aesthetic dual cure resins

Aesthetic dual cure resins
Adhesive resins

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Conventional cementation

Zinc cements
GICs
Resin-modified GICs
Polyacid-modified Resin composites

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Zinc phosphate composition

White powder - zinc and magnesium oxide

Clear liquid - 45-64% aqueous solution of phosphoric acid

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Advantages of zinc phosphate cement

Easy to mix
Sharp and well defined set
Low cost product

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Disadvantages of zinc phosphate cement

Risk of pulpal irritation due to low pH 
No antibacterial action 
Brittle 
No adhesive qualities 
Relatively soluble in oral environment 
Low tensile strength

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Zinc polycarboxylate cement e.g ?

Durelon
White powder - zince with magnesium oxide and stannous fluoride
Clear liquid - 30-40% aqueous solution of polyacrylic acid

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Advantages of zinc polycarboxylate cement

Bond to enamel and dentine as well as some of the metallic cast restorations 
Low irritancy 
Antibacterial action 
Low film thickness
Fluoride release

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Disadvantages of zinc polycarboxylate cement

Properties are highly dependent upon handling procedures
Short working times and long setting times
Bonding needs to be exact
Clean up difficult
Timing critical
Strength and solubility are comparable to zinc phosphate cement
Less adhesion than GIC and resins

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GIC
Indications

Problems

Popularity

Suggestions for use

Fluoride release
Bond to tooth
Low expansion/contraction
Moderate strength

Some post-op sensitivity
Water sensitive during setting

Moderate/high popularity

Good for routine use on crowns and bridges
Suggest the use of a prep desensitiser

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RMGIC examples

Fuji PLUS
Rely-X
Protec-Cem

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Compomer/RMGIC

Strengths

Weaknesses

Popularity

Use suggestions

Fluoride release
Bond to tooth 
Moderate-high strength 
No post op sensitivity 
Low solubility

Little long term experience, SWELLING

Low

Routine use on metal supported crowns and bridges, lab manufactured composites

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Resin bonding to alloys
Interfaces involved
Examples of use

Tooth resin interface/resin metal interface
Resin bonded bridge (Ni-Cr)
Orthodontic bracket (Steel, Co-Cr, Ti)
Intra-oral repair (Au and Pd)
Composite resin facings (Au and Pd, Ni-Cr, Co-Cr, Co-Ni-Cr, Ti)

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Self adhesive resin cements

• Easy to clean
• Dual Cure
• Need light cure as well as chemical cure to ensure full conversion
• Colour
• MaxCem Elite and SmartCem2 claim better translucency and better
colour stability
• Panavia SA Cement may be too opaque
• Enamel Bond
• Significantly better with acid etching, thus not ideal for veneers, inlays,
onlays, RBBs and orthodontic brackets
• Dentine Bond
• Not as good as that obtained with DBAs
• Acid etching compromises the bond
• Bond may be enhanced by pre-treatment with PAA
• Bond to Fibre Posts
• Enhanced when using a silane
• Bond to Zirconia
• Enhanced by using a ceramic primer

Precious metal alloy bonding/intra oral repair uses the method of..

Success rate

Silica Coating

Poor

Types of silica coating

Layers

and mechanism

Silicoater - mixture of silane coupling agent and silica coating
Tribochemical coating - works by causing advancing particle to rebound off coated surface

Metal > silica coating layer from blasting > silane coupling > composite on top

Ideal cement

Long working time
Low film thickness
Low solubility 
High compressibility and tensile strength 
Low viscosity 
Adhere to tooth structure e.g in DBC 
Biocompatible 
Cariostatic 
Translucent/appropriate opacity 
Radiopaque

Acid/Base cements

Zinc phosphate
Zinc polycarboxylate
GIC
ZO cements

Resin modified cement

Resin modified GIC

Polyacrylic modified resin

Polymeric cements

Hydrophobic resin
Hydrophilic resin
Self etching resin
Provisional cements

Resin-bonded bridge

Examples of cement

Phosphonated Panavia
4-META Superbond
Self-adhesive Rely-X

Resin Cements

Strong
Adhesive
Technique sensitive
Chemical, dual or light cure

Hydrophobic Use

``` Technique sensitive Translucent ceramic use Adhesive bridge bonding Requires bonding agent Light/dual cure Glass ceramic ```

Hydrophilic

``` High affinity to non precious metals Adhesive metal bridges Expensive O2 inhibited Chemical/dual cure ```

Self-etch resin

Easy to use Self adhesive to dentine Crown retained bridges Bonding provisional adhesive bridges

Metal primers

Can be used instead to do intra-oral repair Fewer stages Enhance bond strength

Resin bonded ceramics - DBCs and glass ceramics e.g

Lithium disilicate | Etch dissolves glass portion and material integrates into structure

Mechanism at glass-resin interface

Silica oxide and methacrylate bonds at surface. HF etch. Coupling agent integrates as oxide layer

Aesthetic resin luting agents - types

1. Light activated --> Veneers | 2. Dual Cure --> Ceramic crowns

Resin-to-resin bond - used for

1. Incremental build up of direct composites | 2. Prefab resin composites e.g onlays

Cementing temporary restorations - why are they needed

1. Pain 2. Overeruption and space loss 3. Drifting of proximal teeth 4. Damage to core preparations

Functions of temp cement

``` Provide seal Prevent marginal leakage Prevent pulpal irritation Low strength to allow easy removal Protect preparation ```

Ideal properties of temporary cement

``` Ability to seal against oral fluid leakage Strength for easy removal Low solubility Biocompatible Chemicocompatible Easy use Ease of eliminating excess Compatible with final luting agent ```

Materials used for temp cement What not to use

Fine particle ZOE Non-eugenol cement Zinc phosphate, zinc polycarboxylate and GIC are too high strength

Advantages of ZOE

Easy removal Acceptable sealing Easy to use Good for pulp

Disadvantages of ZOE

Reduces surface hardness and strength of methacrylate resin Can affect bond strength of resin cements ENSURE all cement removed