CLASS !

ONONER CENENTS
Dr. N!T!N B. ROHATC!
CONTENTS
!NTRODUCT!ON
DEF!N!T!ON
H!STORY
CLASS!F!CAT!ONS
CONPOS!T!ON
SETT!NC REACT!ON
PROPERT!ES
CL!N!CAL PROCEDURES
!ND!CAT!ONS and CONTRA!ND!CAT!ONS
RECENT ADvANCES
CONCLUS!ON
!NTRODUCT!ON
NAN NADE DENT!N
DEF!N!T!ON
WATER BASED NATER!AL THAT
HARDENS FOLLOW!NC AN AC!D BASE
REACT!ON BETWEEN BAS!C FLUORO
ALUN!NOS!L!CATE CLASS AND AN
AQUEOUS SOLUT!ON OF POLYAC!DS.
H!STOR!CAL BACKCROUND
S!L!CATE CENENTS FLETCHER (1871)
AC!D ETCH!NC BUONOCARE (13SS)
CONPOS!TE RES!N BOWEN (13S8)
POLYCARBOXYLATE CENENTS D.C.SN!TH (1368)
C!C (ASPA !) B.E.KENT S W!LSON (1363)
ASPA !! (1372)
ASPA !!! S !v W!LSON AND CR!SP (13747S)
ASPA W!LSON,CR!SP S ABEL (1377)
ANHYDROUS C!C (ASPA v) PROSSER (1384)
CERNET Nc LEAN S CASSER (138S)
CLASS!F!CAT!ONS
Philips:
TYPE ! LUT!NC
TYPE !! RESTORAT!vE
TYPE !!! L!NER S BASE
Davidson/Njor :
CONvENT!ONAL/TRAD!T!ONAL C!C
RES!N NOD!F!ED C!C
POLYAC!D NOD!F!ED RES!N CONPOS!TES
Nount:
A) Auto Cure
Dual Cure
Triple Cure
B) Type !
Type !!
* Type !! 1
* Type !! 2
Type !!!
C) Class !onomer Cements
a. (i) Class Polyalkeonates
(ii) Class Polyphosphates
b. Resin modified C!C
c. Polyacid modified composite resin
Sturdvent:
1. Conventional or Traditional
2. Netal Nodified C!C
Niracle Nix
Cermet
3. Light Cured C!C
4. Hybrid (resin modified) C!C
S. Polyacid Nodified Resin Composites
According to clinical use as:
Type ! Luting
TYPE !! Restorative
Type !!! Liner/ Base
Type !v Pit S Fissure Sealant
Type v Luting for Orthodontic Purpose
Type v! Core build up material
Type v!! High fluoride releasing command set
Type v!!! ART
Type !X Ceriatric S Paediatric C!C
CONPOS!T!ON
#"%
ALUN!NA (28.6) alumina: silica > 1:2
S!L!CA (41.3)
FLUOR!DE
CALC!UN FLUOR!DE (1S.7)
ALUN!N!UN PHOSPHATE (3.8)
CRYOL!TE
Na
+
, K
+
, Ca
2+
, Sr
3+
La
2
O
3
, SrO
$
POLYACRYL!C AC!D(4S) polyacrylic: itaconic > 2:1
!TACON!C AC!D
NALE!C AC!D
TR!CARBOXYL!C AC!D
TARTAR!C AC!D(S1S)
POLYPHOSPHATES
NETAL OX!DES
WATER
SETT!NC REACT!ON
Decomposition
Nigration
Celation
Post set hardening
Naturation
Role of water
reaction medium
hydrate the matrix
Classification
loosely bound water
tightly bound water
Protection
vaseline
Dentin bonding agents
Optical microscopic section
W!THOUT PROTECT!ON
PROTECTED W!TH RES!N SEALANT
L!FTED SURFACE W!TH SURFACE DECRADAT!ON
EXCELLENT ADAPTAT!ON W!TH CONPLETE !NTECR!TY
CRACK !N UNPROTECTED C!C
CRACK PROPOCAT!ON
W!THOUT PROTECT!ON
W!TH PROTECT!ON
crack
chipping
Factors affecting setting
Chemical constituents
alumina : silica ratio
fluoride
tartaric acid
Particle size
Powder : liquid ratio
Temperature of mixing
PROPERT!ES:
Adhesion:
mechanism of adhesion
1. chelation (Smith)
2. hydrogen bonding (Wilson)
3. diffusion based adhesion (Akinmade)
4. hydroxyapatite S polyacrylic acid reaction
(Beech)
S. hydrogen bonding with dentin collagen
(Akinmade)
D!FFUS!ON BASED ADHES!ON
Bond strength
enamel 2.6 to 3.6 Npa
dentin - 1.1 to 4.S Npa
Surface conditioners
remove smear layer
increases surface energy
increases wettability and decreases
contact angle
Polyacrylic acid 10 for 1S sec
S0 citric acid for S sec
2S tannic acid for 30 sec
2 ferric chloride
EDTA
!TS solution, Levine solution
advantages of adhesion no microleakage
conservative cavity form
iocompatibility
high initial pH mild pulpitis
properties of polyacrylic acid
high mol wt.
weak acid
ppt by Ca in dentinal tubules
electrostatic attraction of H
+
ions
sensitivity with luting C!C
high initial pH
low P : W ratio
pre existing pulpitis
decrease dentin thickness
Anticariogenicity
Fluoride Action
physicochemical mechanism
biologic mechanism
Duration of fluoride release?
Structural degradation?
Fluoride recharge (topping up effect) and fluoride
reservoir
FLUOR!DE RECHARCE
FLUOR!DE RELEASE
TETRAHEDRON CLASS SKELETAL STRUCTURE
F !ON NOT !N STRUCTURE
Aesthetics degree of translucency exist
Dimensional Stability ~ 3 contraction
Dissolution by early water contamination
plaque acid/ APF gel application
mechanical wear
Clinical Life of the restoration
Strength compressive strength 1S0 Npa
tensile strength 6.6 Npa
KHN 48
Radiopacity
CL!N!CAL PROCEDURE
(D!SPENS!NC)
STANDARD!ZE POWDER !N SPOON
D!SPENSE L!QU!D TO AvO!D A!R BUBBLES
N!X!NC
N!X!NC POWDER AND L!QU!D US!NC PLAST!C SPATULA
FOLD!NC TECHN!QUE FOR N!X!NC
NATR!X APPL!CAT!ON
PREFORNED HAWE NATR!CES
SOFT T!N NATR!X
F!N!SH!NC S POL!SH!NC
No finishing for 24 hours.
!f essential, sharp blade to reduce gross
contour
After 24 hours, fine diamond with air/
water spray for gross contour
Rubber polishing points for refining
Polishing discs for glossy finish
sealing with resin sealant or vaseline
!ND!CAT!ONS
LUT!NC CENENT
particle size 4 to 1S
film thickness 10 to 20
P : W ratio - 1.S:1 (low viscosity)
no application of pressure C!C has thixotropic
tendency towards plastic deformation
Conditioning or no conditioning?
on non vital teeth yes
on vital teeth a dilemma
RESTORAT!vE CENENT
erosion/ abrasion lesions
class !!! S v lesions
restoration on primary teeth
restoration in rampant caries cases
laminate restorations
ART
microcavity preparation
small to medium size class ! lesion
repair of open margins around crowns and inlays
P : W ratio - 3:1 (2.3:1 to 3.6:1) for
conventional C!C
For anhydrous C!C - 6.8: 1
L!NER AND BASE
as a liner to protect pulp from thermal insult
as base to replace carious dentin
Nount technique for base application
Sandwich technique
open method dissolution of open C!C margins
closed method C!C margins protected byresin
Exposed margins
Resin covered margins
Pit S fissure sealant
Luting of orthodontic brackets and bands
Core build up
Cement less than 40 of the total core
!n endodontics
Preventive restorations
ART
High fluoride releasing command set
CONTRA!ND!CAT!ONS
Class !v lesions and fractured incisors
Large labial restoration where esthetic
is of prime concern
Lost cusp area
Class !! lesions where conventional
cavities are prepared
RECENT ADvANCES !N C!C
High viscosity C!C
1. Developed as an alternative to amalgam.
2. Also called as pack able / condensable C!C
3. Has increased wear resistance.
4. Decrease moisture sensitivity S solubility.
S. Highly opaque S limited service life.
Low viscosity C!C
1. Also called as flowable C!C
2. Use for lining, pit and fisure sealer, endodontic
sealer and for sealing hyper sensitive cervical
area.
3. Low P:L ratio thus increase flow.
Eg fuji lining LC, ketac - endo etc.
Netal modified C!C
1. Seed S Wilson (1380) invented miracle mix
2. Nc lean S Casser (138S) invented cermet
3. Ninimal improvement in mechanical property
Compressive strength - 1S0 Npa
KHN - 33
Tensile strenght - slightly more 6.7 Npa
Slight increase in wear resistance.

Fluoride release
Nax for miracle mix (33S0g, 4040g)
And min for cermet (200g, 300g)
Esthetically poor, may discolour teeth
Chemical adhesion, Anticariogenicity
and rapid Hardening makes it use as
core build up material
Resin Nodified C!C
1. Defined as hybrid cement that sets partly by
acid base reaction and partly by
polymerisation reaction
2. Developed by Antonucci S Nithra
3. Powder - !on leachable glass and initiators
liquid - water, Poly acrylic acid, HENA
4. Setting reaction - initially acid base reaction,
later polymerization reaction superimposes
over acid base reaction.
S. Dual cure S tricure according to setting
reaction.
Properties
Esthetic - superior than conventional
C!C
Fluoride release - same as conventional
C!C but more for lining version
Strength -
tensile strength(20 Npa)
Compressive strength (10S Npa)
KHN (40)
Adhesion to tooth structure - less than
conventional C!C
Adhesion to composite restoration better than
conventional C!C
Nicroleakage - due to polymerization
shrinkage and reduce water and PAA content
Water sensitivity considerable reduce
Biocompatibility - less than average.
Advantages
Long working time due to photo curing
Decrease sensitivity to water (but not
significantly, ]ournal of Conservative
Dentistry, ]une 200S)
!ncrease early strength
Finishing S polishing can be done
immediately
!mproved tensile strength.
Better adhesion to composite restoration
!ncrease fluoride release.
Disadvantage
Biocompatibility is controversial
Nore setting shrinkage leading increase
microleakage and poor marginal
adaptation
Uses
As a luting cement
As a liner and bases
As a pit and fissure
Core build up material
Retrograde filling material
Polyacid modified composite resin
Also called as compomer
Defined as : material that contain both
the essential components of C!C but in
an amount insufficient to carry out acid
base reaction in dark.
They are developed to combine fluoride
release of C!C and durability of
composite
Composition: one paste system
containing ion leach able glass,
sodium fluoride, polyacid modified
monomer but no water
Recently 2 paste or powder liquid
system is introduced. They are self
adhesive due to presence of water
Setting reaction
1. !nitially light curing forms resin network
around the glass
2. After 2 to 3 month there is water uptake
which initiates slow acid base reaction and
fluoride release.
Properties
Adhesion - absence of water thus no
self adhesion
Fluoride release minimal.
Physical properties better than
conventional C!C but less than
composite.
Uses
Pit and fissure sealant
Restoration of primary teeth
Liners and bases
Core build up material
For class !!! S v lesions
Cervical erosion / abrasion
Advantages
Ease of use
Easy adaptation to the tooth
Cood esthetics
Nore working time than RN C!C
Self hardening RN C!C
Activated purely by chemical
polymerisation reaction
Contains benzoyl peroxide and tamines
Advantages
ease of handling
fluoride release
higher compressive strength
no additional set up for light activation
Fluoride charged material
Consist of 2 part
Restorative part
Charge part
Still under experimental stage
Low pH Smart" Naterial
Releases fluoride when pH falls below
the critical level
Fluoride release is episodic and not
continuous
Bioactive glass
!ntroduce by Hench in 1373
Acid dissolution of glass forms calcium and
phosphate rich layers
The glass can form bioactive bonds with bone cells
Better than hydroxyapatite
Can grow calcium and phosphate rich layer in
presence of calcium and phosphate saturated saliva.
They are less abrasive than feldspathic porcelain to
opposing teeth
uses
Bone cement
Retrograde filling material
For perforation repair
Augmentation of resorbed alveolar ridge
!mplant cementation
!nfra bony pocket correction
Ceramic crown
Ciomer (operative dentistry
200S)
True hybridization of C!C and
composite
Combine fluoride release and fluoride
recharge of C!C with esthetic easy
polishability and strength of composite
Based on PRC technique.
Two types: S PRC S F PRC technique
Eg Beautifil and Reactmer
S PRC Ciomer are indicated in Class !
to Class v! lesions
F PRC Ciomer are indicated only in
cervical erosion and abrasion lesions
Advantages
!ncrease wear resistance
!ncrease Radiopacity (glass filler)
Shade conformity (improved light diffusion
and fluorescence)
High and sustained fluoride release and
recharge
Provide almost complete seal against
bacterial microleakage
Little mechanical and chemical pulp irritation
!nhibit demineralization
Conclusion
With all its limitation, the future of C!C is
hard to measure at this point,
but one thing is obvious it has a future.
References
Recent advances in restorative dental
material - Dr. Nageswar Rao.
Science of dental material - Philips
Operative Dentistry - Sturdevant
Advances in C!C - Davidson S Njor
An Atlas Of C!C - C.].Nount
]ournal of operative dentistry, 200S