Dental Asia March/April 2019

User Report
cements can only be used for temporary
restorations and this is one of their major
drawbacks. This restriction is attributed
to the poor physical and mechanical
properties of glass ionomer cements.
Affordable alternatives wanted
Composite resins and more modern
adhesive systems have led to significant
improvements in aesthetics, minimal
invasiveness and mechanical properties.
In fact, they have eliminated all drawbacks
that the clinician faces when using silver
amalgam or glass-ionomer cements.
However, composite materials have
always been perceived as expensive,
time-consuming and technique sensitive.
Although they have been available on the
market for a number of years, they have
never fully eliminated the demand for
conventional basic filling materials such
as silver amalgam and glass- ionomer
cements in spite of their drawbacks.
This left dentists waiting for an effective
alternative that can be used as basic filling
material. For many years, it was a pipe
dream that there would be an affordable,
easy-to-use, fluoride-releasing material
that would not necessitate the use of
complicated equipment, would provide
adequate aesthetic properties and would
be suitable for use in stress-bearing areas
without restrictions.
Finally, a material that offers exactly
these advantages has become available:
Cention N is an ideal alternative to basic
filling materials. It is the protagonist of
a new category of self-curing materials.
Cention N: an overview
Cention N is an alkasite filling material
that is available in a powder-liquid delivery
form. It is a self-curing resin-based
material offering optional light-curing
with a curing device emitting light in the
wavelength range from 400 to 500 nm.
It does not necessitate the use of an
adhesive protocol. As a result, retentive
preparation is required to place Cention N.
Yet, the adhesive technique can be used
if a minimally invasive approach involving
the use of a tooth-preserving preparation
method is required. Cention N is available
in commercial packages that contain a
bottle of each liquid and powder and a
spatula to mix the components.
Attractive for users
The main features that make Cention N
an attractive choice for users are:
1. Strength: The filling material is suitable
for use in stress-bearing areas due to its
strength. It offers a flexural strength of
100 MPa, which is considerably higher
than the strength of glass ionomer
cements.
2. Ion release on demand: If the critical
pH drops severely in response to
an acid attack, the fillers release
fluoride, calcium and hydroxyl ions.
The hydroxyl ions have a neutralising
effect on the surrounding pH:
H + → + OH - H2O
Calcium and fluoride ions promote
the remineralisation of the tooth
structure by forming calcium fluoride
and calcium phosphate. They reduce
demineralisation.
In-house studies have shown that
the formation of fluorapatite crystals
results in a surface deposit of almost
0.5 μm. A study that has been ongoing
for more than a year has shown that
ion release per se does not lead to a
significant change in the mechanical
properties of the filling.
The name of the filling material is
based on its flexural strength of
over 100 MPa and its ion release:
CENT + ION = Cention.
3. Lifelike appearance: The material
is supplied in shade A2. This shade
blends well into the surrounding tooth
structure. The material’s aesthetic
properties are therefore superior to
those of any glass-ionomer cement
currently available.
4. Easy to use: Only four working steps
are required: dispense – mix – restore
– finish. This makes the material
easy to use without the need of any
complicated equipment.
5. Affordable: Cention N is extremely
cost effective. A 30 g powder bottle
provides sufficient material for almost
160 fillings enabling clinicians to reach
all segments of patients.
Cention N in clinical use
Indication and contraindication
Cention N is suitable for use without an
adhesive in Class I and II restorations, in
conjunction with a retentive preparation
design, provided that the distance
between the cavity margins and the cusp
tip is larger than 1 mm. However, it is
contraindicated for restoring proximal
boxes and for replacing cusp tips if an
adhesive is not used.
Cavity preparation
Generally, a retentive preparation design
is required if no adhesive is used. The
preparation walls should be occlusally
convergent, with a minimum convergence
of 2 degrees. The depth of the cavity
should be at least 1.5 mm. The width of
the cavity should be at least 1.5 mm in the
isthmus area. If the clinician feels that it
is unnecessary to remove tooth structure
to achieve this cavity design, the cavity
may be prepared conservatively. In this
case, an adhesive should be used prior
to placing Cention N. If the cavity floor is
close to the pulp, all applicable protocols
for pulp protection should be followed.
Isolation and matrix application
Fillings placed with Cention N do not
necessitate any particular isolation
measures. A rubber dam is not required
and retracting the cheeks with an
OptraGate and cotton rolls is more than
enough. It is essential to place a matrix
band if a Class II cavity is restored. A
sectional matrix system is preferable.
Dispensing and mixing
As mentioned earlier, it is necessary to
shake the powder bottle prior to use. Only
MARCH / APRIL 2019 DENTAL ASIA 49