Dental Cements Ppt 6r541k

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

 2004, Bayne and Thompson, UNC School of Dentistry.

RETENTION BY DENTAL CEMENTS Coarse and fine micromechanical retention

DENTIN

DENTAL TS ADHESIVE SYSTEM or LUTING CEMENT

Adherend

ENAMEL, DENTIN > Liner, Base, Cement > Post and Core > Dental Amalgam > Implant >

Adherend

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

Crown

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

CEMENT FACTS: • • • • • • • •

???

Tooth Structure

Fluid Flow

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.

CEMENT MICROSTRUCTURE Ceramic POWDER Particles (BASIC) Inorganic or organic LIQUID (ACIDIC)

Residual POWDER Particles (FILLER) Acid-Base Salt (REACTION PRODUCT)

Powder reinforces set cement matrix Zinc Phosphate Cement

OVERVIEW OF DENTAL CEMENTS Cement Type:

(Abbr.)

LIQUID

POWDER

Zinc Oxide Eugenol: ZOE Reinforced ZOE ZOE-EBA HV-EBA

(ZOE) (RZOE) (EBA) (HV-EBA)

Eugenol Eugenol Eug, EBA HV, Eug

ZnO ZnO, Polymer, Rosin ZnO, Al2O3, Rosin ZnO, Al2O3, Rosin

Zinc Phosphate Silicate Zinc Silicophosphate

(ZP) (SC) (ZSP)

H3PO4 / H2O H3PO4 / H2O H3PO4 / H2O

ZnO F-Al-Silicate glass ZnO, F-Al-Silicate

Polycarboxylate Glass Ionomer: Conventional Resin-Modified Compomer

(PC)

PAA / H2O

ZnO

(GI) (RMGI) (CM)

PAA / H2O F-Al-Silicate Glass “ + HEMA, … F-Al-Silicate Glass (Monomers) F-Al-Silicate Glass

Composite (with DBS) (CC, )

(Monomers)

(Silicate glass fillers)

Dental Cement Timeline 1850

1900

1950

2000

ZOE ZP

SC PCC Compomer GI RMGI CC Contemporary Practice

Generations of Cements

Zinc Phosphate

Polycarboxylate

Resin-Modified Glass Ionomer

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) --1% --Zinc Phosphate 22% 12% 10% Polycarboxylate 33% 17% 5% GI, RMGI , Compomer 42% 65% 75 % Resin (Composite) 2% 6% 10% MultiLink

3M-ESPE RelyX UNICEM

IVOCLAR / VIVADENT

SETTING REACTIONS Final Set

75

% CONVERSION

% CONVERSION

100

50

25

0.1

1.0

10

es Large Indentor

50 Initial Set

es Small Indentor

25

100

1000

TIME

TIME

(hrs) Mixing Time

Mixing Interval

Working Time

Working Interval

Setting Time

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

ZOE R-ZOE ZOE-EBA HV-EBA ZP PC GI RMGI Composite

Physical Properties

Chemical Properties

Mechanical Properties____

Setting

∆l (µ (µm/cm)

Solubility

CS

(w/o, 37°C, 7d)

(psi, 37°C, 7d)

-31 to -85 ---- to ----12 to -24 ---- to ---+15 to -7 +50 to +420 ??? ??? ???

0.02 to 0.10 ---- to ------- to 0.40 ---- to 0.01 0.05 to 0.10 0.04 to 0.08 ??? ??? ???

2000 to 5500 10000 to 15000 -------- to --------------- to -------19000 to 21000 8000 to 18000 18000 to 24000 24000 to 30000 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. In a clinical study of three luting cements, 547 bridges and 162 crowns were permanently cemented. Patients were recalled at 6month intervals and the restorations were examined for looseness. A pattern of retainer type, cement type and retainer success was demonstrable.

5-Year Cement Retention: Reinforced ZOE, ZOE-EBA Zinc Phosphate Polycarboxylate

Crowns 98% 100% 96%

Bridges 92% 98% 95%

CEMENT AGING SOLUBILITY and DISINTEGRATION ADA Test

ZINC PHOSPHATE CEMENT

Multifactorial Solubility and Disintegration Events

Water Zn(OH)2 Mg(OH)2 Zn(PO4)2 H2O, Lactic acid Na+, ClFCa+, K+

Cement ZnO (and MgO), Tertiary ZP Crystals

CROWN

CEMENT THICKNESS (100 µm)

100 90 80

CROWN

70 60 50 40

???

30

TOOTH STRUCTURE

Powder CRACK LARGE CEMENT THICKNESS: Particle PORE Erosion • 110 µm is average and 50-350 is typical. • ≤100 µm is generally ideal. New considered Phase RETENTION? Precipitation SEALING?

20 10 0 TOOTH

RELATIVE STRENGTH (%)

100

80

60 y = 100e-0.0598x R2 = 0.9101

40

20

0 0

20

40

60

80

100

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

CEMENT MANIPULATION

“20 different experienced dental assistants mixing the same cement”

Frequency (n)

Success / Failure Factors: MEDIAN (1) (2) (3) (4) (5)

5 4

Operator Design Factors Materials Factors Intraoral Location Factors Patient Factors

3 2 1 40

50

60

70

80

90

Compressive Strength (MPa)

ZOE-EBA Traditional Ceramic Dental Cement

ZnO

Eug + EBA ZnO

CH2-CH=CH2

(Zinc Eugenolate)

HO OCH3 (Eugenol)

CH2-CH=CH2

H3CO HO

Zn+2

HO

ZnO +

OCH3 OCH2-H3 (EBA)

COOH

CH2=CH-CH2

OCH2CH3 C-OH +2 O O- Zn HO-C H3CH2CO

(Zinc Ethoxy Bemzoate)

ZINC PHOSPHATE CEMENT Setting Reaction

ZnO

H3PO4 in H2O

ZnO + 2H3PO4 + H2O Zn(H2PO4)2- nH2O Cautions: Do not use on RDT < 1.0 mm

ZnO

Zn(H2PO4)2-H2O on mixing Zn3(PO4)2- 4H2O (tertiary zinc phosphate)

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 0

1 hr 10

100

1 day 1,000

TIME (minutes) pH 7 6 5 4 3 2 1

Mixing, Working, Setting Intervals

1 week 10,000

SILICATE CEMENT Silico-phosphate = Traditional Ceramic Filling Material

SiO2, Al2O3, Na, Ca, F

H3PO4 in H2O

SiO2, Al2O3, Na, Ca, F

Si+4 Al+3 Na+ Ca+2 FPO4-3

Residual Glass Particle SiO2, Al2O3, Na, Ca, F

Alumino-silico-phosphate GLASS Si+4, Al+3, Ca+2, Na+, F- Ions

POLYCARBOXYLATE CEMENT Polymer-Based Dental Cement Zn+2 -OOC -HOOC --- COOZnO

PAA in H2O

-- COOZnO

-- COOH Zn+2 -OOC --

-- COO- Zn+2 -- COO-OOC --OOC --- COOH Residual Glass Particle ZnO

ZINC POLYACRYLATE GEL

Mixing Procedure and Precautions Polycarboxylate Cement A

C

Dispensing P and L.

Folding P into L. D B

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 FPAA

Residual Glass Particle SiO2, Al2O3, Na, Ca, F

POLYACRYLATE GEL (initially Ca polyacrylate gel and later Al polyacrylate gel) Si+4, Al+3, Ca+2, Na+, F- Ions

GLASS IONOMER CEMENT Reactions Ca+2 Al+3 Si+4 F-

H-O-H

¯OOC

COO¯ COO¯

--O --O-Si+4(OH)2

F-AlAl-SiO2, CaF2

H-O-H COO¯ COO¯

H-O-H

¯OOC

Ca+ COO¯ COO¯

COO¯ COO¯

¯OOC COO¯ COO¯ Ca++ ¯OOC

¯OOC Ca+ ¯OOC

COO¯ COO¯ ¯OOC

COO¯ COO¯

¯OOC Al+3 COO¯ COO¯

H-O-H

H-O-H

Hydrophobic POLYMER

GIOMER

COMPOMER

§ VLC Composite and § Pre-reacted GIC powder

§ VLC Composite and § F source

FILLING MATERIALS

Universal CEMENTS FILLING MATERIALS

COMPOSITE CEMENTS FILLING MATERIALS

RM-GIC § GIC and § VLC Hydrophilic monomer and polymer

CEMENTS

MM-GIC

GIC

RR-GIC

§ GIC and § Metallic fillers § Cermet fillers

§ GIC and § Resin-Fillers

A.R.T. and TEMPORARIES

CORES HYDROGEL

Slow long-term F-ion release by diffusion from particle.

Rapid early F-ion release from matrix.

15 F-1, Ca+2, Al+3, Si+4

Cement Matrix

10

5

FluoroFluoroAluminoAluminoSilicate Particle

ST A F

SLOW

F- 1

Dissolution of particle edge for reaction.

MATRIX

FLUORIDE RELEASE (ppm)

20

PARTICLES

0

7

14

TIME (Days)

21

28

15

EFFECTIVE LEVELS 10 RECHARGING: • Fluoride Toothpaste, • Topical Fluoride, • Fluoride Mouthrinse

5

MATRIX

FLUORIDE RELEASE (ppm)

20

PARTICLES

0

7

14

TIME (Days)

21

28

CERAMIC BONDING HF ETCHING • HighHigh-Leucite Porcelains • HighHigh-Alumina Porcelains • Alumina Cores (ProCera) • Zirconia Cores (Cercon, Lava)

ENAMEL CERAMIC INLAY

AcidAcid-etched enamel and dentin Dentin bonding system

DENTIN

RESIN INLAY CEMENT Resin Cement = Composite

HF acidacid-etched surface Silanated / Bonded surface

DENTAL CEMENT EXAMPLES A. Zinc Oxide Eugenol Cements: Cements: ZOE 2200 (LD Caulk) ZOE (J. Bird Moyer Co.) ZOE Temporary (LD Caulk) ZOGENOL (Stratford Cookson) Cookson) Reinforced ZOE Cements (RZOE): ZOE B+T (LD Caulk) IRM (LD Caulk) FYNAL (LD Caulk) ZEBACEM (LD Caulk) OPOTOW ALUMINAALUMINA-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 ZZ-M (Teledyne) KENT ZINC CEMENT (Stratford Cookson) Cookson) LANGLANG-C+B Only (Lang) S-C (Stratford Cookson) Cookson) DROPSIN (Atwood Industries) ELITE (I.D.T. Corp) D. Silicate Cements (SC):

E. Zinc SilicoSilico-phosphate Cements (ZSP): AMES PLASTIC Porcelain (Teledyne) ASTRALIT (Premier) SYNTREX F (Premier) SILICAP (HD Justi) Justi) F. Polycarboxylate Cements (PC): TYLOK (LD Caulk) DURELON (Premier) CHEMIT (Harry J. Bosworth) CARBOXYLON (3M) POLYPOLY-F (DeTrey (DeTrey)) G. Glass Ionomer (GI): ASPA (LD Caulk) IONOMER (Denmat (Denmat)) FUJI II (GC America) KETACKETAC-CEM (ESPE)) BIOBOND LUTING (Harry J. Bosworth) AQUACEM (DeTrey (DeTrey)) BASELINE (DeTrey (DeTrey)) ResinResin-Modifed Glass Ionomer (RMGI): FUJI I (GC) FUJI PLUS (GC(GC-America) RELYRELY-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(3M-ESPE) MaxCem (Kerr) MultiLink (HeraeusHeraeus-Kulzer) 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) DUODUO-CEMENT (Coltene (Coltene)) CALIBRA (LD Caulk) OPAL LUTING (3M) COMPOLUTE (ESPE) CEMENTCEMENT-IT (Jeneric/Pentron (Jeneric/Pentron)) LUTELUTE-IT (Jeneric/Pentron (Jeneric/Pentron)) BUILDBUILD-IT (Jeneric/Pentron (Jeneric/Pentron))

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