Advanced Cementation Update
Webinar
Webinar
October 14th
The Why, Where, & When
of bite relationships
John Nosti, DMD
www.clinicalmastery.com
david@hornbrook.com
Cementation
Adhesion
“total-etch”, resin cement
Semi-adhesion
Self-etching resin cement
Non-adhesion
Glass Ionomer, resinionomer, zinc
phosphate, polycarboxylate
Cement Requirements
Lack of post-operative sensitivity
Strong bond and good seal
-to the tooth and to the restorative material
Easy placement and clean-up
Esthetics compatible with the restorative
material
Minimal film thickness
Radiopaque (posterior)
“Total-etch”
with
Resin Cement
Powder liquid ceramic
or
Pressed ceramic restorations
“Tack & Wave”
Cementation
Veneers and anterior crowns
Emprethin evaluation
Be Careful!!!
0.2 mm glass is fragile!
OptraGate (Ivoclar)
Hydrogen Peroxide in Ultradent Syringe
Metal strip removes any interproximal Luxatemp and
freshens the enamel
Try in independently DRY
Occlude Spray Powder (Pascal)
Try-in collectively DRY!
Check complete seating
Proximal contacts
Mesial Surface
Dry Erase Marker
Distal
Surface
Variolink Veneer
(Ivoclar/Vivadent)
Value based
0
+1, +2, +3
-1, -2, -3
Microfill
0
+2
Clean and acidify with 35% Phosphoric acid
Silane Coupling Agent (Relyx Ceramic primer) placed for 1 minute
Place bonding agent (All Bond 3) inside dry restoration
Load restoration with resin cement
Vivapad (Ivoclar)
Etch with 35% phosphoric acid for 15 seconds per tooth
Apply Systemp desensitizer for 15 seconds
Effect of Remoistening
Water vs. Desensitizer/Rewetting
Agent
Product
Water-blotted dry
Water- wet
Gluma Desensitizer
HurriSeal
Vivadent Desensitizer
MicroPrime
Aqua-Prep
Dentinal Bond
22.8
19.2
22.3
20.1
25.8
20.1
18.1
“suction” away excess; do not desiccate
Apply 2 coats of All Bond 3 A & B Primer mix
Adec Warm Air Tooth Dryer
Seat all restorations at one time; do not remove
excess resin cement
Polymerize “dead center” each restoration for 1 second
using a 2.0 mm light guide (Ivoclar)
Hold light guide 1 inch from restorations
and light cure 3-5 seconds on facial and lingual
General Guidelines
+2: 5 seconds
0: 3 seconds
-3: 5 seconds +
“Pick" away excess using Bard Parker or scaler
Floss through contacts using a Brasseler Serrated Saw
Floss through contacts using waxed dental floss
Place DeOx (Ultradent) on all margins
Light polymerize for at least 60 seconds
per tooth from both buccal and lingual
Curing Lights
Photoinitiators
Camphoroquinone- 470-490 nm
PhenylDipropandione- 430 nm
CQ 488 nm
PDP 430 nm
40
30
20
10
CQ
0
300
350
400
450
500
600
Wavelength (nm)
OptiLux 501
(Demetron)
Emits light with wavelength
390-510 nm
CQ 488 nm
PDP 430 nm
40
30
20
10
CQ
0
300
350
400
450
500
600
Wavelength (nm)
LED Light
i.e.. Freelight (3M), LEDemetron
(Kerr),,BluPhase (Ivoclar), DEMI (Kerr)…
-No bulb degradation
-Portable
-Wavelength output 450-500 nm
CQ 468 nm
PDP 430 nm
40
30
20
10
CQ
0
300
350
400
450
500
600
Wavelength (nm)
Emits light with wavelength
390-510 nm
BluePhase G2
(Ivoclar)
Fusion
www.dentlight.com
Remove excess resin cement with Scaler,
#12 & #15 Bard-parker Blades
Run Serrated Saw through contacts
1954N Strip (3M)
Epitex Strips (GC)
15 micron finishing diamond (Brasseler))
15 micron football-shaped diamond on lingual
OptraFine Porcelain polishing system (Ivoclar)
DiaShine ( V & H )
Solid Model Contacts
Adhesion to the restoration
Ceramist etches in lab
Clinician cleans internal surfaces
with phosphoric acid
Rinse and dry thoroughly
Apply Silane coupling agent
Apply dual-cure adhesive resin to
internal of restoration
Adhesion to the restoration
Ceramist etches in lab
Clinician cleans internal surfaces
with phosphoric acid
Rinse and dry thoroughly
Apply Silane coupling agent
Apply dual-cure adhesive resin to
internal of restoration
Blot Dry dentin
Apply primer
Air dry primer
Light polymerize for 10 seconds
Posterior
RelyX ARC (3M)
Hold passively for 3 minutes
Remove excess with
scaler or explorer
Floss through contacts
Cover margins with
oxygen-inhibiting medium
Light polymerize for
at least 60 seconds
Use scaler and/or
#12 Bard Parker
Core-reinforced Restorations
Zirconia
Alumina
Metal
Lithium disilicate (e.Max)
Pressed Ceramic/
Powder-liquid ceramics
“Core” reinforced ceramic
(Metal, zirconium, lithium disilicate, alumina oxide)
High technique sensitivity
 “Total-etch”
resin cements
 Conventional cements
 No etch Adhesive cements
e.Max Pressed
Lithium disilicate pressed
“Core” reinforced ceramic
(Metal, zirconium, lithium disilicate, alumina oxide )
 Conventional cements
(Zinc phosphate, polycarboxylate,
Glass ionomer)
 No etch Adhesive cements
(Resin-ionomers, self-adhesive resin cements)
“Core” reinforced ceramic
(Metal, zirconium, lithium disilicate, alumina oxide)
No etch adhesive cements
 Resin Modified glass ionomers
(FujiCem, FujiPlus, RelyX Luting)
 Self-adhesive resin cements
(Unicem, MaxCem, Multilink Automix, Panavia FL)
“Self-adhesive” resin cements
(the benefits of resin without the technique sensitivity)
 Single component Self-Adhesive
(Unicem, MaxCem, others)
 Assisted Self-adhesive resin cements
(Multilink Automix, Panavia FL)
“Single Component Self-adhesive “ cements
Unicem (3M)
Embrace
MaxCem Elite (Kerr)
Embrace Wetbond ( Pulpdent)
G-Cem (GC)
BisCem (Bisco)
“Single Component Self-adhesive “ cements
BisCem (Bisco)
Embrace
“Single Component Self-adhesive “ cements
Bond strengths (Reality)
Dentin
Enamel
MaxCem
Unicem
BisCem
3.8
7.7
9.0
8.8
16.6
15.0
“Total-etch”
Relyx
30.3
25.4
Embrace
Advantages of
“Single Component self-adhesive” cements
 Good physical properties
 Some adhesive properties
 Very, very easy to use
Disadvantages of
“Single Component self-adhesive” cements
 Mediocre bonds to dentin and enamel
Questionable long term enamel bonds
 Questionable bonds to restorative
substrate
Assisted “Self-etch” resin cements
Panavia FL2.0
(Kuraray)
Bistite II DC
(J. Morita)
Multilink Automix
(Ivoclar)
Advantages of
Assisted “Self-adhesive” cements
 Good physical properties
 Good adhesive properties
 Easier to use than “Total-etch” cements
Assisted “Self adhesive” cements
Bond strengths (Reality)
Dentin
Enamel
Panavia F 2.0
Bistite II
Multilink
7.6
14.7
15.1
11.5
12.7
16.4
“Total-etch”
Relyx
30.3
25.4
Embrace
Disadvantages of
Assisted “Self-adhesive” cements
 Involves an adhesive step
Bonds not as strong as “Total-etch”
Can we “etch “with phosphoric acid
with self-etch cements?
Enamel Bonds
Total-etch
Self-etch
Panavia F 2.0
Unicem
Multilink
18.3
16.6
21.2
11.8
8.5
16.4
BisCem
15.0
13.8
Decreased bond strengths to dentin
When do I use what?
Non-core supported ceramic:
“Total etch”
Core-supported Ceramic
Minimal retention and resistance form?
“Total-etch” with dual cure resin cement
Adequate retention and resistance?
“self-adhesive” resin cements
Hornbrook 2009 Updates –
Full Day Events
Topics include:
•2009 Materials Update
•My top 10 failures and how YOU can avoid them!
•Treatment Planning the Full Mouth Rehabilitation
•Winning Case Presentation Techniques for a Tough
Economy
•Prepless Veneers: Necessary Addition to Your
Restorative Arsenal
•And much more!
November 6th – Albuquerque, NM
November 13th – Boston, MA at Tufts University