Dental-Cements-PPT [للقراءة فقط]

DENTAL CEMENTS
for Luting and Bonding
Stephen C. Bayne
Operative Dentistry
UNC School of Dentistry
Chapel Hill, NC 27599-7450
7450
2004, Bayne and Thompson, UNC School of Dentistry.

RETENTION BY DENTAL CEMENTS
Coarse and fine micromechanical retention
DENTIN

DENTAL JOINTS
ADHESIVE SYSTEM
or LUTING CEMENT
Adherend
Adherend
ENAMEL, DENTIN >
Liner, Base, Cement >
Post and Core >
Dental Amalgam >
Implant >
< Composite, Amalgam
< Cast Inlay, Onlay, or Crown
< All-ceramic Inlay, Onlay, or Crown
< Veneers, Maryland Bridges
< Orthodontic Brackets

GOALS:
• Retention / resistance form
• Sealing (No fluid flow or ML)
Crown
Microleakage
???
Tooth
Structure
CEMENT FACTS:
• No correlation of lab and clinical performance.
• RMGI for metal substructures and composite for ceramics.
• Failure occurs by fatigue – crack formation and propagation.
• Compositions and properties constantly changing.
• Cements are theoretically strong enough.
• Initial effectiveness requires “retention and sealing.”
• Cement more stable at enamel rather than dentin margins.
• Highest stress in cements occurs at margins.
Fluid
Flow

CEMENT MICROSTRUCTURE
Ceramic POWDER Particles
(BASIC)
Inorganic or organic LIQUID
(ACIDIC)
Residual POWDER Particles
(FILLER)
Acid-Base Salt
(REACTION PRODUCT)
Powder reinforces set cement Zinc matrix
Phosphate Cement

OVERVIEW OF DENTAL CEMENTS
Cement Type:
(Abbr.)
LIQUID
POWDER
Zinc Oxide Eugenol:
ZOE
Reinforced ZOE
ZOE-EBA
EBA
HV-EBA
Zinc Phosphate
Silicate
Zinc Silicophosphate
Polycarboxylate
Glass Ionomer:
Conventional
Resin-Modified
Compomer
(ZOE)
(RZOE)
(EBA)
(HV-EBA)
(ZP)
(SC)
(ZSP)
(PC)
(GI)
(RMGI)
(CM)
Eugenol
Eugenol
Eug, EBA
HV, Eug
ZnO
ZnO, Polymer, Rosin
ZnO, Al 2 O 3 , Rosin
ZnO, Al 2 O 3 , Rosin
H 3 PO 4 / H 2 O ZnO
H 3 PO 4 / H 2 O F-Al-Silicate glass
H 3 PO 4 / H 2 O ZnO, F-AlF
Al-Silicate
PAA / H 2 O
ZnO
PAA / H 2 O F-Al-Silicate Glass
“ + HEMA, … F-Al-Silicate Glass
(Monomers)
F-Al-Silicate Glass
Composite (with DBS) (CC, CP)
(Monomers)
(Silicate glass fillers)

Dental Cement Timeline
1850 1900 1950
2000
ZOE
ZP
SC
PCC
GI
Compomer
RMGI
CC
Contemporary Practice

Generations of Cements
Zinc Phosphate Polycarboxylate Glass Ionomer
Resin-Modified Glass Ionomer
Composite Cement
What do you use ???

Clinical Research Associates. Materials use survey.
CRA Newsletter. 1990;14(12):1; 1995;19(10):3-4; 2001…
Dental Cement Use
1990
1995
2001
• EBA (ZOE)
• Zinc Phosphate
• Polycarboxylate
• GI, RMGI, Compomer
• Resin (Composite)
1%
22%
33%
42%
2%
---
12%
17%
65%
6%
---
10%
5%
75 %
10%
MultiLink
3M-ESPE RelyX UNICEM
IVOCLAR / VIVADENT

SETTING REACTIONS
100
% CONVERSION
75
50
25
% CONVERSION
50
25
Initial
Set
Final
Set
Passes
Large Indentor
Passes
Small Indentor
0.1
1.0 10 100 1000 (hrs)
TIME
TIME
Mixing
Time
Working
Time
Setting
Time
Mixing
Interval
Working
Interval
Setting
Interval
Initial
Set
Final
Set

DENTAL CEMENT PROPERTIES
PHYSICAL PROPERTIES:
-- Coefficient of Thermal Expansion
-- Thermal Conductivity
MECHANICAL PROPERTIES:
-- Compressive Strength
-- Tensile Strength
-- Shear Strength
-- Bond Strength
CHEMICAL PROPERTIES:
-- Solubility and Disintegration
-- Absorption
BIOLOGICAL PROPERTIES:
-- Chemical Irritation of Pulp During Setting
CROWN
TOOTH
STRUCTURE

DENTAL CEMENT PROPERTIES
Physical
Properties
Chemical
Properties
Mechanical
Properties____
Setting
Solubility
CS
Dl l (mm/cm)(
m/cm) (w/o, 37°C, 7d) (psi, 37°C, 7d)
ZOE
-31 to -85
0.02 to 0.10 2000 to 5500
R-ZOE
---- to ---- ---- to ---- 10000 to 15000
ZOE-EBA
EBA -12 to -24
---- to 0.40 -------- to --------
HV-EBA
---- to ---- ---- to 0.01 -------- to --------
ZP
+15 to -7 0.05 to 0.10 19000 to 21000
PC +50 to +420 0.04 to 0.08 8000 to 18000
GI ??? ??? 18000 to 24000
RMGI ??? ??? 24000 to 30000
Composite ??? ??? 35000 to 45000
???

Silvey RG, Myers GE.
Clinical study of dental cements. VII. A study of bridge
retainers luted with three different dental cements.
J Dent Res 1978;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 Bridges
Reinforced ZOE, ZOE-EBA 98% 92%
Zinc Phosphate 100% 98%
Polycarboxylate 96% 95%

CEMENT AGING
SOLUBILITY and DISINTEGRATION
ADA
Test
Multifactorial
Solubility and Disintegration
Events
ZINC
PHOSPHATE
CEMENT
Water
Zn(OH) 2
Mg(OH) 2
Zn(PO 4 ) 2
H 2 O, Lactic acid
Na + , Cl -
F -
Ca + , K +
Cement
ZnO (and MgO),
Tertiary ZP Crystals

CEMENT THICKNESS (100 mm)
100
90
80
70
60
50
40
30
20
10
0
CROWN
TOOTH
???
CROWN
TOOTH
STRUCTURE
Powder
CRACK
CEMENT LARGE
Particle
THICKNESS:
PORE
Erosion
• 110 µm is average and 50-350
is typical.
• £100
µm is generally New considered Phase
ideal.
RETENTION?
SEALING?
Precipitation

100
RELATIVE STRENGTH (%)
80
60
40
20
y = 100e -0.0598x
R 2 = 0.9101
0
0 20 40 60 80 100
POROSITY (%)
Ryskewitsch. J Am Ceram Soc 1953;36:65. (Empirical suggestion s =s o exp(-nP)
where n=4-7 and P=volume fraction porosity.)

CEMENT MANIPULATION
“20 different experienced dental assistants mixing the same cement”
Frequency (n)
5
4
3
2
1
MEDIAN
Success / Failure Factors:
(1) Operator
(2) Design Factors
(3) Materials Factors
(4) Intraoral Location Factors
(5) Patient Factors
40 50 60 70 80 90
Compressive Strength (MPa)

ZOE-EBA
EBA
Traditional Ceramic Dental Cement
ZnO
Eug
+
EBA
ZnO
HO
(Zinc
Eugenolate)
CH 2
-CH=CH 2
ZnO +
OCH 3
(Eugenol)
CH 2
-CH=CH 2
OCH 2
-H 3
(EBA)
COOH
H 3
CO
Zn
HO
+2
OCH 3
CH 2
=CH-CH 2
HO
OCH 2
CH 3
C-OH
- O
O - Zn +2
HO-C
(Zinc
Ethoxy
Bemzoate)
H 3
CH 2
CO

ZINC PHOSPHATE CEMENT
Setting Reaction
ZnO
H3PO4
in
H2O
ZnO
ZnO + 2H3PO4 + H2O
Zn(H2PO4)2- nH 2 O
Zn(H2PO4)2-H2O on mixing
Zn3(PO4)2- 4H2O
(tertiary zinc phosphate)
Cautions:
Do not use on RDT < 1.0 mm

Mixing Procedure and Precautions
Zinc Phosphate Cement
Chilled glass slab
and dispensing P.
Fleck’s
Mizzy
ZP Cement
Dividing P portions
and dispensing L.
Incremental additions
and stropping.

CEMENT ACIDITY ON SETTING
Zinc Phosphate Cement
Mix
1 hr
1 day 1 week
0 10 100 1,000 10,000
pH
7
6
5
4
3
2
1
Mixing,
Working,
Setting
Intervals
TIME (minutes)

SILICATE CEMENT
Silico-phosphate = Traditional Ceramic Filling Material
SiO 2 ,
Al 2 O 3 ,
Na, Ca,
F
H 3 PO 4
in
H 2 O
SiO 2 ,
Al 2 O 3 ,
Na, Ca,
F
Si +4
Al +3
Na +
Ca +2
F -
PO4 -3
SiO 2 ,
Al 2 O 3 ,
Na, Ca,
F
Residual Glass Particle
Alumino-silico-phosphate GLASS
Si +4 , Al +3 , Ca +2 , Na+, F - Ions

POLYCARBOXYLATE CEMENT
Polymer-Based Dental Cement
ZnO
PAA
in
H 2 O
ZnO
HOOC --
Zn +2
-- COO-
-- COO-
Zn +2
-OOC --
-OOC --
-- COOH
-OOC --
-- COO-
Zn +2
-- COO-
-OOC --
-- COOH
ZnO
Residual Glass Particle
ZINC POLYACRYLATE GEL

Mixing Procedure and Precautions
Polycarboxylate Cement
Dispensing
P and L.
A
C
Folding P
into L.
B
D
E
Stropping.

GLASS IONOMER CEMENT
Hybrid = SC(P) and PCC(L), Polymer-Based Dental Cement
SiO2,
Al2O3,
Na, Ca,
F
PAA
in
H2O
SiO2,
Al2O3,
Na, Ca,
F
Si +4
Al +3
Na +
Ca +2
F -
PAA
SiO 2 ,
Al2O3,
Na, Ca,
F
Residual Glass Particle
POLYACRYLATE GEL
(initially Ca polyacrylate gel
and later Al polyacrylate gel)
Si +4 , Al +3 , Ca +2 , Na+, F -
Ions

GLASS IONOMER CEMENT
Reactions
H-O-H
Ca +2 Al +3 F - Si +4
¯OOC
COO¯
F-Al-SiO2,
CaF2
--O-Si+4(OH)
Si+4(OH)2
H-O-H
¯OOC
H-O-H
Ca+
COO¯
COO¯
COO¯
¯OOC
Ca+
¯OOC
¯OOC
¯OOC
COO¯
COO¯
Ca++
COO¯
¯OOC
¯OOC
Al+3
H-O-H
H-O-H
COO¯

GIOMER
• VLC Composite and
• Pre-reacted GIC powder
FILLING MATERIALS
COMPOMER
• VLC Composite and
• F source
Universal
CEMENTS
FILLING MATERIALS
Hydrophobic POLYMER
COMPOSITE
CEMENTS
FILLING MATERIALS
RM-GIC
• GIC and
• VLC Hydrophilic
monomer and polymer
CEMENTS
MM-GIC
• GIC and
• Metallic fillers
• Cermet fillers
CORES
GIC
HYDROGEL
RR-GIC
• GIC and
• Resin-Fillers
A.R.T. and
TEMPORARIES

FLUORIDE RELEASE (ppm)
20
15
10
5
MATRIX
PARTICLES
Cement
Matrix
Fluoro-
Alumino-
Silicate
Particle
Rapid early
F-ion release
from matrix.
Ca +2 ,
Si +4
F - 1 , Ca
Al +3 , Si
FAST FAST
SLOW F -1
Dissolution of particle
edge for reaction.
Slow long-term F-ion
release by diffusion
from particle.
0
7
14 21 28
TIME (Days)

FLUORIDE RELEASE (ppm)
20
15
10
5
MATRIX
PARTICLES
EFFECTIVE LEVELS
RECHARGING:
• Fluoride Toothpaste,
• Topical Fluoride,
• Fluoride Mouthrinse
0
7
14 21 28
TIME (Days)

CERAMIC BONDING
ENAMEL
Acid-etched
enamel
and dentin
Dentin
bonding
system
RESIN
INLAY
CEMENT
CERAMIC
INLAY
HF acid-etched
surface
Silanated / Bonded
surface
HF ETCHING
• High-Leucite Porcelains
• High-Alumina Porcelains
• Alumina Cores (ProCera)
• Zirconia Cores (Cercon, Lava)
DENTIN
Resin Cement
= Composite

DENTAL CEMENT EXAMPLES
A. Zinc Oxide Eugenol Cements:
ZOE 2200 (LD Caulk)
ZOE (J. Bird Moyer Co.)
ZOE Temporary (LD Caulk)
ZOGENOL (Stratford Cookson)
Reinforced ZOE Cements (RZOE):
ZOE B+T (LD Caulk)
IRM (LD Caulk)
FYNAL (LD Caulk)
ZEBACEM (LD Caulk)
OPOTOW ALUMINA-EBA (Getz)
AURACEM (DMG Hamburg)
B. Hexyl Vanillate Cements (HV):
(None currently marketed)
C. Zinc Phosphate Cements (ZP):
MODERN TENACIN (LD Caulk)
FLECK'S EXTRAORDINARY (Mizzy(
Mizzy)
SMITH'S ZINC CEMENT (Teledyne)
AMES Z-M Z M (Teledyne)
KENT ZINC CEMENT (Stratford Cookson)
LANG-C+B Only (Lang)
S-C C (Stratford Cookson)
DROPSIN (Atwood Industries)
ELITE (I.D.T. Corp)
D. Silicate Cements (SC):
E. Zinc Silico-phosphate Cements (ZSP):
AMES PLASTIC Porcelain (Teledyne)
ASTRALIT (Premier)
SYNTREX F (Premier)
SILICAP (HD Justi)
F. Polycarboxylate Cements (PC):
TYLOK (LD Caulk)
DURELON (Premier)
CHEMIT (Harry J. Bosworth)
CARBOXYLON (3M)
POLY-F F (DeTrey(
DeTrey)
G. Glass Ionomer (GI):
ASPA (LD Caulk)
IONOMER (Denmat(
Denmat)
FUJI II (GC America)
KETAC-CEM CEM (ESPE))
BIOBOND LUTING (Harry J. Bosworth)
AQUACEM (DeTrey(
DeTrey)
BASELINE (DeTrey(
DeTrey)
Resin-Modifed
Glass Ionomer (RMGI):
FUJI I (GC)
FUJI PLUS (GC-America)
RELY-X X LUTING (VITREMER CEMENT) (3M)
ADVANCE (LD Caulk)
PRINCIPLE (LD Caulk)
NEXUS (Kerr)
DYRACT CEM (Dentsply)
PERMACEM (DMG Hamburg)
VITREBOND CEMENT (3M)
Compomer
UniCem (3M-ESPE)
MaxCem (Kerr)
MultiLink (Heraeus-Kulzer)
H. (Resin) Composite Cements (CC):
COMSPAN (LD Caulk)
PANAVIA F (Kuraray)
PANAVIA 21 (Kuraray)
ENFORCE (LD Caulk)
RESIN CEMENT (3M)
NEXUS (Kerr)
MEGABOND (Harry J. Bosworth)
DUO-CEMENT (Coltene(
Coltene)
CALIBRA (LD Caulk)
OPAL LUTING (3M)
COMPOLUTE (ESPE)
CEMENT-IT (Jeneric/Pentron(
Jeneric/Pentron)
LUTE-IT (Jeneric/Pentron(
Jeneric/Pentron)
BUILD-IT IT (Jeneric/Pentron(
Jeneric/Pentron)

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