INTRODUCTION

CEMENTS FOR LUTING

CEMENTS FOR PULP PROTECTION

1. Cavity Varnishes
2. Cavity Liners
3. Cavity Bases

CEMENTS FOR RESTORATION

1. Zinc Phosphate
2. Zinc Polycarboxilate
 INTRODUCTION
• Dental Cements are materials that set intraorally and that are commonly used to join a
tooth and a prosthesis.

• They are supplied as powder and liquid or as two pastes.

• Liquids are usually acidic(proton donors) and powders are basic. Mixing these starts a
chemical reac on (usually acid-base reac on)

• MTA undergoes hydra on reac on whereas resin cements set by polymeriza on reac on.

• Depending on viscosity and strength, cements can be used as varnish, lu ng agents, base
for pulp protec on and permanent or temporary restora on.
 LUTING
CEMENTS
• Lu ng cements are used to a ach dental appliances
and prosthesis to teeth.

• Cement fills the irregular crevices and forms void

free con nuum to resist shear stresses. This
mechanical reten on may be insufficient and can be
improved by chemical adhesion.

• Glass Ionomer Cement (GIC)- based on polyacrylic acids, bond to teeth by chela ng acrylic acids to
both organic and inorganic tooth components.
• They con nue to cure even a er se ng me(7 min) and if allowed to mature free of
contamina on, increase in strength and become more resistant to dissolu on.

Hydrophilic den ne bonding agents penetrate pores in den ne created by acid etching ; these
also have high bond strength through micromechanical reten on. Resin cements bond to calcium
within den n.
To choose a cement for a specific task, one must consider the following:
1. The cement’s physical and biological proper es.
2. The cement’s handling characteris cs, such as working me, se ng me, consistency
and ease of removing excess material
 LUTING INTERFACE
• Lu ng cements are designed to fill the microscopic gaps
between a prosthesis and a prepared tooth.
• A cement should flow under pressure and wet the surfaces
while forming con nuous film without forming voids.
 PROCEDURE FOR LUTING A SINGLE CROWN
• Lu ng of a single crown is described in three steps:
• Cement Placement
• Sea ng of crown
• Excess cement removal

Cement Placement-
• Cement should coat en re inner surface of crown and extend slightly over the
margin. It should fill half of inner cavity volume of crown and should be free of
bubbles.
• Air entrapment in cri cal occlusal region can lead to fracture of a ceramic
prosthesis under mas catory force.
• Filling en re crown cavity increases risk for bubble entrapment, the me and
pressure required for sea ng, and the me and effort to remove excess cement.
SEATING-
• Use moderate finger pressure to displace excess cement
and seat the crown on the prepared tooth. Tapping,
vibra on of crown or using ultrasonic device may also
help for complete sea ng.
• Evaluate at least three points of margin with an explorer
before cement sets to ensure adequate sea ng.
• Ask pa ent to bite down on wood or co on roll to
ensure complete sea ng and expelling excess cement.

3 CHARACTERISTICS MAKE SEATING EASIER:

1. Low viscosity cement
2. More taper on prepared teeth
3.Decreases height of prepared tooth
But higher taper and lower tooth height compromise the
reten on.
REMOVAL OF EXCESS CEMENT-
• Zinc phosphate or zinc oxide eugenol(ZOE) cements do not adhere
to the surrounding surfaces, the tooth, or the prosthesis.
• So let cement set completely before the excess cement is removed.
• Glass Ionomer, polycarboxylate, and resin cements adhere
chemically and physically.
• So remove as soon as the sea ng is completed to prevent
adhesion to exterior of prosthesis or surrounding teeth.
• A separa ng medium, like petroleum jelly, can be applied on
surrounding ssues and external surface to inhibit cement,
adherence.
• Some GICs and dual cure resin cements can be removed 1.5-3
minute. At this point cement has some strength but not enough
strength and hence large pieces of excess cement can be removed.
• Zinc polycarboxylate cement transforms to a rubbery stage before se ng and
any a empt to remove excess may pull cement away from marginal area or
from within the prosthesis.

• Regardless of cement, run a kno ed dental floss through interproximal regions

towards the margins immediately a er complete sea ng of the prosthesis.

• The knot removes most of excess cement and provides be er access for
cement removal required a er cement has set.
 DISLODGEMENT OF
PROSTHESIS
• Debonding may be caused by cement fracture, dissolu on or erosion,
secondary caries, or excessive shear forces.
• Cements with higher bond strength are preferred as the cement layer is the
weakest link of a prosthe c/tooth assembly.
• In oral environment, lu ng cements may dissolve and erode leaving space for
plaque accumulate and caries may recur.
• Apply a coat of varnish or bonding agent along margins of cemented
restora ons to allow me for matura on while free of contamina on and to
make it resistant to dissolu on.
• Cement layer should be sufficiently thin to minimize pores.
• Design of prosthesis should allow the cement to flow and result in a uniform layer of cement.
• Thinner cement layers also decrease plaque accumula on and microleakage.
• Coefficient of thermal expansion between tooth, prosthesis and cement should be similar over
the range of temperature associated with consumed food and beverages.
• Dislodgement is minimized in cements with high bond strength(chemical bonding).
• Failure may occur through cement layer
As fig. A
This is unlikely because of small thickness of cement
involved.

• Failure may occur at interface specially in case of

mechanical bonding. Fig B
• Most common is lu ng agent/prosthesis interface.
 FILM
THICKNESS
• It refers to the thickness of a con nuous cement a er se ng under pressure, according to ANSI/ADA
Specifica on no. 96 (ISO 9917-1).
• Film thickness is an indica on of the viscosity of cement during sea ng.
• For lu ng applica ons, the maximum allowable film thickness 25 µm is preferred, so that excess cement
can be expressed more easily.
• For root canal sealers maximum film thickness is 50 µm .
• Cement thickness refers to the thickness of cement between the tooth structure and the prosthesis.
• An acceptable cement thickness range from 25 to 120 µm but for resin cements, it can exceed 150 µm.
• IT PLAYS A SIGNIFICANT ROLE IN THE RETENTION OF PROSTHESIS AND VARIES WITH-
1. The amount of force applied during sea ng of prosthesis.
2. The direc on of force applied to the prosthesis during sea ng.
3. The design of the prosthesis rela ve to its poten al to inhabit or facilitate the flow of cement.
4. The fit of the prosthesis on the prepared tooth.
5. The inherent film thickness of the cement.
 • CEMENTS FOR
PULP PROTECTION
• Specialized materials like cavity varnishes, liners and base materials are used in prepared
cavity to protect the pulp from thermal or chemical irrita on.

CAVITY VARNISHES
• Varnishes are composed of natural gums or synthe c resins dissolved in an organic solvent.
• Varnish has a high solvent content which evaporates and leaves a thin coa ng. Hence, at
least two thin layers should be applied using disposable brush or pledget of co on to
prevent leaving small pinholes.
• It is claimed that- Varnish reduces the infiltra on of irrita ng fluids through marginal
crevices and lessens pulpal irrita on. Also they prevent penetra on of corrosion products
of amalgam into den nal tubules.
• Varnish is not indicated when adhesive material is being used for resin based composite.
• Den ne bonding agent serves the same purpose as varnish.
CAVITY LINERS:
• Liners do not possess strength or thermal insula on capability but can induce
forma on of secondary den ne.
• Calcium hydroxide is chief ingredient for many liners and bases because it is
an microbial, has elevated pH and s mulates forma on of secondary den ne over
injured pulp.
When it is placed on pulpal floor, solvent evaporates and leaves film of calcium
hydroxide.
Calcium hydroxide gets inac vated a er forming Calcium Carbonate.
Since Calcium hydroxide is soluble in water, it must not be le on the margin of the
prepared cavity.
Some adhesive liners also have func on of sealing den nal tubules.
Calcium Hydroxide liners are commonly used for direct and indirect pulp capping and
as a dressing a er vital pulpotomy on deciduous teeth.
MTA is newer cavity liner material that forms Calcium Hydroxide as it sets.
Cement Bases:
• They are applied in thicker layers(greater than 0.75mm) beneath restora ve
materials to protect pulp against thermal injury, galvanic shock and chemical
irrita on.
• Zinc Phosphate and ZOE cements are commonly used, as well as some
polycarboxylate and fast se ng GICs.
• Zinc phosphate is effec ve base for thermal insula on, but low pH may require
a cavity liner underneath. It can also be mixed in pu y consistency with less
acid to reduce risk of pulp exposure to low pH.
• When glass ionomer is used as base in deep cavi es, a calcium hydroxide liner
is applied first to protect areas where pulp exposure is more likely to occur.
• Bases should be strong enough to withstand forces during the placement of
fillings and mas ca on forces during service.
• Restora ve materials should be placed a er the ini al
set of the base cement has occurred.
• Strength of bases increases rapidly over the first 30
minutes and con nues to increase over me.

• A base cement should be selected a er considering-

 The design of the cavity
 The direct restora ve procedure
 The proximity of the pulp chamber rela ve to the
cavity floor or wall.
• For amalgam restora ons, Calcium Hydroxide and ZOE liners are effec ve
base materials.
• For Direct Filling Gold restora ons, a stronger base like Zinc Phosphate,
polycarboxylate or GIC is indicated due to its duc lity.
• If a Zinc Phosphate base is used, varnish should be applied to cavity walls
before placement of base.

• For more biocompa ble base materials(Calcium Hydroxide, ZOE,

polycarboxylate and GIC), the base cement is placed first, followed by the
cavity varnish a er the base has hardened.

• For the resin-based composites, Calcium Hydroxide and GIC are sa sfactory
base cements.

• MTA can also be used as base because of its insula ng, an -microbial and
non-acidic proper es, but it has the disadvantage of longer se ng me.
• CEMENTS FOR
RESTORATION
 ZINC PHOSPHATE

• Zinc Phosphate cement first appeared in 1879 and the chemistry of modern
day cement was established in 1902.

• Chemistry and Se ng-

• Zinc Phosphate cement consists of powder and liquid which are mixed just
before use.
• The powder contains more than 75% od Zinc Oxide and up to 13% of
Magnesium Oxide.
• The liquid controls contains Phosphoric acid(38-59%), water(30-55%),
aluminium phosphate(up to 10%). The liquid controls the pH and the rate of
reac on.

• On mixing, phosphoric acid dissolves the Zinc Oxide, which reacts with
aluminium phosphate and forms zinc aluminophosphate gel on the remaining
undissolved zinc oxide par cles.

• Set cement contains unreacted ZnO par cles encased in an amorphous matrix
of zinc alumino-phosphate.
 CLINICAL
MANIPULATION
• The reac on between Zinc oxide and phosphoric
acid is exothermic.
• Powder should be dispensed on a glass slab and
divided into several por ons.
• Liquid should not be dispensed on the glass slab
un l the powder is dispensed and divided, and the
cement is ready for use because the water from the
liquid will evaporate.
Mixing of Zinc Phosphate Cement-
• Start by mixing smallest por on of powder using a thin spatula and brisk
spatula on.
• U lize most are of mixing slab to dissipate heat.
• Spatulate each increment for 15-20 seconds before adding another increment.
Mixing should be completed within 1.5-2 minutes.
• A er the powder is completely incorporated and creamy mixture created,
cement is drawn across the slab and the flat blade of the mixing spatula
contacts the mixture and is slowly drawn away.
• If string of cement can be li ed 12mm to 19mm before separa ng from
spatula, the cement is considered fluid enough for cemen ng a prosthesis.
Removal of excess cement:

• Excess cement must be removed from the interproximal area immediately

with a kno ed dental floss a er sea ng.

• Remaining cement should be allowed to set before removal.

• Layer of varnish or other impermeable coa ng should be applied at the

margins a er removal of all excess material.
Control of working me:

• Some procedures like a fixed prosthesis with mul ple crowns may require
more working me for cementa on.

• 4 techniques can be used to extend working me-

1. The P/L ra o can be reduced to produced a thinner mixture. However,

this change will result in a lower pH and will adversely affect the
mechanical proper es of the cement.
2. Smaller por ons of powder should be mixed for the first few increments.
Ini al small increments of powder dissolve in the liquid, which reduce acidity
and retard the reac on rate with subsequent increments.
• Meanwhile, the heat generated will be dissipated sufficiently during
spatula on. If a large por on of powder is used ini ally, the quan ty of heat
generated can not be dissipated fast enough to prevent it from accelera ng
the reac on.

3. By increasing spatula on of the last increment of the powder.

• The spatula on effec vely destroys the matrix as it forms, which means that
extra me is needed to rebuild the bulk of the matrix. This is not the preffered
method.
4. In a colder mixing temperature, the mixing reac on will be
retarded.
• However, the temperature of the slab should be above the dew point, otherwise,
water will condense and dilute the liquid leading to reduced compressive and tensile
strength of cement.
• Using a cool slab is the most viable method of extending the working me and this
should apply whenever mul ple unit prosthesis are being cemented as the
procedure yields lower cement viscosity.

Reten on-

• Zinc phosphate bonds only mechanicaly to teeth or prosthesis.

• A cavity liner applied on the tooth surface for pulp protec on before applica on of
Zinc phosphate will reduce reten on by crea ng a smoother surface with less
interlocking.
  MECHANICAL AND BIOLOGICAL
PROPERTIES
• Zinc phosphate lu ng cements have a compressive strength as high as 104
Mpa, a diametral tensile strength of 5.5 Mpa, and an elas c modulus of 13 Gpa.

• Generally, Zinc phosphate cements have low solubility in water, however in

vivo disintegra on can occur in presence of lac c, ace c, and citric acids.

• The presence of phosphoric acid makes the cement cytotoxic.

• As se ng occurs, the acidity is par ally neutralized, but cement remains acidic
a er 24 hours, with the pH rising from about 3 to 6 hours.

• For thin layer of den n, a cavity liner is recommended to prevent an adverse

pulpal reac on.