DENTAL CEMENTS

 BY
PRANALIKA KANOJIYA
MDS 1ST YEAR
 CONTENTS

Introduction
Definition
Ideal properties
Classification
Based on Ingredients & Application (According to Craig)
Based on Bonding Mechanism (According to William O'Brien)
Based on Uses (According to Philips)
 Silicate cement
 Zinc phosphate cement
 Silicophosphate cement
 Zinc polycarboxylate cement
 Zinc Oxide Eugenol cement
Modification
Reinforced Zinc Oxide Eugenol
EBA
 Glass ionomer cement
 Calcium Hydroxide cement
 MTA Cement
 Resin Cements
 Conclusions
 References
 INTRODUCTION
 In last 20 years there has been an explosion of different
types of dental cements that have become available to
practicing dentist ,many of them tailored for specialized
types of restoration. In fact ,there are so many products to
choose from the task ,can become confusing.

Dental cements, in the recent years has become
restricted to those materials which are employed to bond
inlays, crowns, bridges, posts and facings in or on the tooth
and to retain orthodontic bands and retainers, however
secondary applications of these cements include cavity
linings, bases and temporary fillings, endodontic sealer

Craig and John M Restorative Dental Materials 12th th edition

 These different applications make varying
demands on manipulative properties, working
and setting times, and resistance to mechanical
breakdown and dissolution. Thus some materials
are better suited to some application than
others.
 Many of these materials are supplied in
powder/liquid form and set by an acid-base
reaction, but this is not universally true.
 As yet, there is no ideal dental cement. Each
material must be used on its merits with
knowledge of its limitations.

Craig and John M Restorative Dental Materials 12th edition

DEFINITIONS OF CEMENT

 Substance that hardens to act as a base, liner, filling

material or adhesive to bind devices and prosthesis to
tooth structure or to each other.(Philips )

 A non metallic material used for luting ,filling permanent

or temporary restorative prosthesis made by mixing
components into a plastic mass that sets or as an adherent
sealer in attaching various dental restorations in or on the
tooth.(Craig)
 Ideal Properties of Dental Cement

Should be strong and hard.

Able to protect pulp
Should be insoluble in saliva & liquids taken in mouth.
Should be dimensionally stable.
Should be adhesive .
Should be non porous .
Should be biocompatible and non irritant.
Co-efficient of thermal expansion should be equal to the
tooth structure.
Should not be affected by thermal changes and
moisture.
Should be easy to manipulate.

Philips Science of Dental materials 11th edition

 CLASSIFICATION:

BASED ON INGREDIENTS AND APPLICATION(CRAIG 12TH EDITION)

 Water based cement
o Glass & Resin modified glass ionomer
o Zinc Phosphate
 Resin based cements
o Composite & adhesive resin
o Compomers
 Oil based cements
o Zinc Oxide Eugenol
o Non Eugenol -Zinc Oxide
WATER BASED CEMENT
 1) Glass & Resin modified glass ionomer cement :
Class V restoration
- Retention of- Conventional alloy based restoration
Orthodontic bands
Alumina or zirconia based all ceramic restoration
- High strength bases
- Long term provisional restoration
 2) Zinc phosphate :
- Retention of- Conventional alloy based restoration
-Orthodontic bands
- High strength bases
- Long term provisional restoration
RESIN BASED CEMENTS
 1. Composite & adhesive resin :
- Bonding- Conventional alloy based restoration
-Ceramic crowns, bridges ,veneers, inlays,
onlays.
- Post & cores
- Retention of - Provisional restoration
- Orthodontic bands
 2. Compomers:
- Bonded conventional alloy based restoration
- Retention of - Alumina or zirconia based all ceramic
restoration
- Orthodontic bands
High strength bases
OIL BASED CEMENTS

 Zinc Oxide Eugenol :

High strength bases

Provisional restoration
Root canal sealers
Gingival tissue packs
Surgical dressing

 Non Eugenol -Zinc Oxide:

Provisional restoration
Root canal sealers
Gingival tissue packs
Surgical dressing
 Based on the bonding mechanism(Williams O'Brien 4th edition)
Phosphate based :
Zinc phosphate cement
Modified zinc phosphate cement
Fluoridated cement
Copper cement
Silicophosphate cement
 Phenolate based :
Zinc oxide eugenol cement
Reinforced zinc oxide eugenol
EBA and other chelate cements
Calcium hydroxide chelate cement
 Polycarboxylate based:
Zinc polycarboxylate cement
Glass ionomer cement
 Methacrylate based:
Acrylic cements
BIS-GMA type cements
According to Philips on bases of its use
 Classification (E.C. Combe 6th edition)
 Acid base reaction cements.
Zinc phosphate
Zinc polycarboxylate
Zinc oxide eugenol
Silicate
Glass ionomer cement
 Polymerising materials
Acrylic polymer
Cyanoacrylates
Dimethacrylate polymers

 Other materials
i) Calcium hydroxide
ii) Guttapercha
iii) Varnishes.
 CHARACTERISTIC PROPERTIES OF
DENTAL CEMENTS
 FILM THICKNESS AND CONSISTENCY:-

 It greatly determines the adaptation of the restoration to the

tooth.
 The retention may also be influenced by the film thickness

 ANSI/ADA specification no:96 has requirements for cement designed

for seating of precision appliances.

MAXIMUM FILM THICKNESS 25µ m

 Craig and John M Restorative Dental Materials 12th edition

 The heavier the consistency ,the greater the film thickness and the less
complete the seating of the restoration.

 The ultimate film thickness that a well-mixed ,nonangular cement attains

depends first on the particle size of the powder,the concentration of the
powder in the liquid,the viscocity of the liquid,and the consistency of the
cement.

 The film thickness also varies with the amount of force and the manner in
which this force is applied to a restoration during cementation.

Craig and John M Restorative Dental Materials 12th edition

 The consistency of the cement to be used in the
cementation of a casting is critical.

 Eg:-in a powder/liquid type of cement ,an increased

amount of powder incorporated into the liquid will
increased the consistency of the cement mass.

 Heavier than normal inlay seating consistencies of cement

are more difficult to express from under a restoration,and
incomplete seating of the inlay or crown may result from
their use .

 The operator must frequently test each mass as the end of

the mixing time is approached.
VISCOSITY
 The consistency of cements can be quantified by measuring viscosity .
 Increases in temperature and time have both been shown to increase the
viscosity of some cements
 The rapid increase in viscosity with time demonstrates the need for
prompt cementation after the completion of mixing to take advantage of
the lower viscosity of the cement.
 Delays in cementation can result in considerably larger values of film
thickness and insufficient seating of the restoration.
 For resin cements,viscosity can vary widely ,and in fact ,some products
come with a choice of different viscosities.

Craig and John M Restorative Dental Materials 12th edition

SETTTING TIME
Of equal importance to the viscosity of the cement is its setting time.

A sufficient period of time must be available after mixing to seat and finally
adapt the margins of a restoration or to properly contour a base or
provisional restoration.

Adequate working time is expressed by net setting time,which ,

as ,determined by ANSI /ADA specification no.96 and based on
a luting consistency ,is between 2.5 and 8 minutes at a body temperature of 37° C.

The setting time test measures the time at which the cement is
sufficiently hard to resist indentation by a standard indenter
 The net setting time should occur within 2.5 to 8 minutes so that final
finishing procedures associated with the restoration can occur.

 The first 60 to 90 seconds are consumed by mixing the cement,so the net
setting time is the time elapsed between the end of mixing and the time of
setting, as measured by resistance to a standard indenter.

 One advantage of light –cured resin cements is the fact that there is
virtually an unlimited setting time with low ambient lightening prior to
light –curing.

Craig and John M Restorative Dental Materials 12th edition

STRENGTH

 ANSI/ADA Specification no.96(ISO 9917)stipulates that the standard luting

consistency of a dental cement must exhibit a minimum 24-hour compressive
strength of 70MPa

SOLUBILITY

Solubility in water and oral fluids is also an important consideration in cement

properties.
Water based cements are more soluble than resin-or- oil-based cements.
ANSI/ADA Specification no 96 allows a maximum rate of acid erosion ,which is
variable for the different types of cements,when a cement is subjected to lactic
acid erosion by an impinging jet technique
 REMAINING DENTIN THICKNESS
Type of material to be used depend on minimum dentin
thickness left between the pulp floor and dental pulp(remainin
dentin thickness ie RDT

STURDEVANTS ART AND SCTIENCE OF OPERATIVE DENTISTRY

 1. shallow preparations RDT >2mm
 Cavity varnish only to be given on all internal surfaces(for metallic restorations)

 2 . Moderately deep preparations (<2mm RDT)

 Base must be given on pulpal
and axial floor(0.5 -0.75mm)

STURDEVANTS ART AND SCTIENCE OF OPERATIVE DENTISTRY

 3.very deep preparations (< 1mm RDT)
 Cavity liner is given on all internal surfaces
Over which a Base is given.

STURDEVANTS ART AND SCTIENCE OF OPERATIVE DENTISTRY

 CEMENTS FOR PULP PROTECTION
 Pulpal protection requires consideration of
 1) chemical protection
 2)electrical protection
 3)thermal protection
 4)pulpal medication
 5)mechanical protection

 Metallic restorations are excellent thermal conductors,but they promote thermal

sensitivity when hot and cold foods or beverages are consumed.

 Cements containing phosphoric acid ,direct filling resins, and some glass ionomer
cements cause a chemical irritation.
 The inflammation caused by chemically irritating cements increases in
the order of polycarboxylate cements,zinc phosphate cement,and GIC.

 The setting contraction of amalgam or composite can lead to marginal

leakage as well as pulpal irritation.

 CAVITY VARNISH,LINERS,AND BASE MATERIALS have been used as

adjuncts to restorative materials to protect the pulp from such injuries
Schematic view of needs for pulpal
protection below metallic restoration
Use of liners and bases for amalgam

STURDEVANTS ART AND SCIENCE OF OPERATIVE DENTISTRY PG 407

 CAVITY LINER
 Calcium hydroxide is the chief ingredient in many cavity liners and cement base materials
because calcium hydroxide is
 Antimicrobial
 Has an elevated Ph(basic,alkaline)
 Stimulates the formation of secondary dentin over an injured pulp to protect it over the long
term.

 As a cavity liner ,the calcium hydroxide powder is suspended in a solvent carrier with a
thickening agent.
 When it is placed on the pulpal floor,the solvent evaporates and leaves a thin film of calcium
hydroxide .

PHILIPS SCIENCE OF DENTRAL MATERIALS (1st south asia edition)

 The liner does not possess significant mechanical strength or thermal
insulation capability but it can neutralize acids that migrate towards the
pulp and in the process ,it can induce the formation of secondary dentin.

 Eventually the calcium hydroxide forms calcium carbonate and becomes

inactive.

 Calcium hydroxide is soluble in water and must not be left on the margins
of the prepared cavity or the margins will not be properly sealed.

 Many formulas that are available for cavity lining materials are based on
adding calcium hydroxide to low –viscosity ZOE,GI,or resin cement.

 Some of these liners adhere to tooth –restoration interface,therefore the

function of liners has been expanded to include the sealing of dentin from
potential influx of microorganism and irritants from restorative
procedures.
 Calcium hydroxide liners are commonly used for direct and
indirect pulp capping and as a dressing after vital
pulpotomy procedures on primary teeth.

 MTA is a newer cavity liner that forms calcium hydroxide as

it sets.

 Both MTA and calcium hydroxide undergo a transformation

of hydroxide to calcium carbonate from exposure to co2 in
the blood and oral fluids ,causing their antimicrobial
effectiveness to diminish.
 CEMENT BASES
 Cements bases are applied in thicker layer (greater than 0.75mm)beneath restorative
materials to protect pulp against thermal injury ,galvanic shock,and chemical
irritation.

 Temperature changes have a more acute effect on the pulp when teeth containing
large amalgam fillings are not insulated by a base.

 Zinc phosphate and ZOE cements are commonly used as well as some polycarboxylate
and fast setting GICs .

PHILIPS SCIENCE OF DENTRAL MATERIALS (1st south asia edition)

 Zinc phosphate and ZOE cements are better insulators than
metals,although they have less insulating ability than
portland cement corkboard or glass.
 The insulating abilities of polycarboxylate,glass ionomer,
and calcium hydroxide materials also fall within this range .
 Their actual heat transfer is more complex and depends on
the materials heat capacity ,thickness and density.
 Zinc phosphate cement is an effective base for thermal
insulation,but its low pH (acidity)may require a cavity liner
under the cement to protect the pulp.
 However the risk of low pH in contact with the pulp is
minimized if the zinc phosphate cement is mixed to a thick
,nontacky ,putty-like consistency ,which does not have
excess acid.

 Calcium hydroxide,ZOE,polycarboxylate,and glass ionomer

cement are effective barriers against the penetration of
irritating constituents from restorative materials.

 When glass ionomer is used as a base, a calcium hydroxide

liner should be applied 1st to protect the deep areas where
pulp exposure is more likely to occur
 Cement bases should be strong enough to withstand forces
during the placement of fillings and mastication forces
during service.
 Restorative materials should be placed after the initial set
of the base cement has occurred.
 Their strength increases rapidly over the 1st 30minutes and
continues to increase over 24 hours
 The minimal strength required to resist masticatory forces has not been
determined because of their complexity and the influence of the design of
the prepared tooth cavity .

 For a class I tooth preparation where the base is supported on all the sides by
tooth structure ,less strength is necessary than required for class II
restorations

 A base cement should be selected after considering the design of the cavity
,the direct restorative material, and the proximity of the pulp chamber
relative to the cavity floor of wall.
 For amalgam restorations,calcium hydroxide and ZOE
materials are more effective base cements.

 For direct filling gold restoration,which are relatively

ductile,a stronger base cement such as zinc phosphate
,polycarboxylate,or GIC is indicated.

 Where liners of calcium hydroxide or ZOE cement on the

cavity floor is desired the liner should be overlaid with a
strong base cement.
 Neither microleakage nor acid penetration is prevented by
using a base cement in conjunction with amalgam or direct-
filling gold foil.

 When a cavity varnish or dentin bonding agent is indicated

to seal a restoration,the base often governs the order of
material application .

 If a zinc phosphate cement base is used, a sealing(varnish )

material should be applied to the cavity walls before
placement of the base.

 For the more biocompatible cement base materials(eg

calcium hydroxide,ZOE,polycarboxylate,and GIC),the base
cement is placed ,followed by the cavity varnish after base
has hardened.
 For resin –based composites ,calcium hydroxide and GIC
are satisfactory cements.

 MTA is also used as a base because it is insulating

,antimicrobial and nonacid.

 However ,currently available products have slow setting

characteristics.

 Thus MTA is primarily a specialty material.

SILICATES
 Introduced in 1903 as
anterior filling materials.
Silicates are attacked
by oral fluids and in
time degrade,
They may not be
considered permanent
restoration.
The uses of silicate
cements diminished
with the advent of
composite resins and
development of GIC.
COMPOSITION
POWDER
Silica
Alumina
Fluoride compounds
Calcium salts

LIQUID
Phosphoric acid
Water
Buffer salts
 Fluoride Flux -
To permit proper sintering
of the other ingredients.
 SETTING REACTION

 Powder mixed with liquid

 Powder attacked by acid liquid releasing Ca, Al, Fl

ions

 Metal ions precipitate as phosphate

 Cement matrix inclusive of Fl salts

 Setting time 3 to 6 minutes
 ADVANTAGES

 It exhibit good esthetic qualities

 Anticariogenic property.
 Analogues to topical applied fluoride solution.

 DISADVANTAGES

 It lacks stability in oral fluids with loss of esthetic qualities

 Irritant to pulp.
 ZINC PHOSPHATE CEMENT
 Introduced over a
century ago It is the
oldest luting cement.
 Longest clinical track
record to compare
with newer systems.
 Synonyms `Crown and
Bridge’ and “Zinc
oxyphosphate’
 It has low film thickness and sufficient working time to allow complete seating of restoration.
 Initially on mixing it has low pH, which can irritate the pulp (less than 4) and gives rise to transient
pain but reaches neutrality by 48hrs
 APPLICATIONS

Luting of restorations
High strength bases
Temporary restorations
Luting of orthodontic bands and brackets.

CLASSIFICATION
ADA specification No.8. Designates them as
1. Type I – Fine grained for luting
Film thickness should be 25  or
less
2. Type II - Medium grain for luting and filling.
Film thickness should not be
more than 40 
MODE OF SUPPLY

 Available as;Powder and liquid system.

COMMERCIAL NAMES

Confit
Harvard
Zinc cement improved
COMPOSITION

Powder

Zinc oxide - 90.2% - Principle

constituent
Magnesium oxide - 8.2% - Aids in Sintering
(reduce temperature)

Other Oxides
Bismuth trioxide, Calcium oxide, Barium oxide – 0.2% - Improves smoothness of mix.
Silica – 1.4% - Filler

Liquid
Phosphoric Acid - 38.2% - Reacts with zinc oxide
Water - 36% - Controls rate of reaction
Alumimium phosphate -16.2% act as buffer
Aluminium -2.5%
Zinc-7.1%
 CALCINATION PROCESS

The ingredients of the powder are heated together at temperature ranging

from 1000C to 1300C for approx 4 to 8 hours or longer depending on the
temperature. This calcination results in a fused or sintered mass this mass is
ground and pulverized to a fine powder, which is sieved to recover selective
particle sizes.

 LIQUID

Aluminum and zinc is added to liquid, partially it will neutralized the H3PO4
and temper the reactivity of the liquid and is described as buffering.

 WATER

Presence of additional water shortens the setting time. Insufficient amount of

water increases setting time
Exothermic reaction
 Powder & liquid mixed

Phosphoric acid attacks the surface of particle

Release of zinc ions & reaction of Al with phosphoric acid

Al & Zn ions react with phosphoric acid

Zinc alumino phosphate gel

and surrounds with un reacted particle
 Thus the set cement is a cored structure consisting primarily of unreacted Zinc Oxide
particles embedded in a cohesive amorphous matrix
of zinc aluminophosphate.
Water is critical to reaction.
MIXING PROCEDURE
 P/L1.4gm /o.5 ml
INITIAL STAGE

By the initial incorporation of small portions of the powder into the liquid minimal
heat is liberated and easily dissipated the heat of the reaction is most effectively
dissipated when the cement is mixed.

 Over a large area

 Over a cooled glass slab
 With a relatively long narrow bladed stainless steel spatula.

During the neutralization of the liquid by the powder the temperature of

the mixing site is inversely proportional to the time consumed in
accomplishing the mix. If a large volume of powder is carried to the liquid all at
once results in increase in temperature at reaction site and speeds the reaction
and hinders control over consistency.
 MIDDLE STAGE – II
During this stage larger amount can be incorporated to further saturate the liquid with
newly forming complex phosphate’s, the quantity of unreacted acid is less at this time
because of the prior neutralization gained from adding small increments of the initial
powder the amount of heat liberated will be less and can be dissipated adequately by
the cooled glass slab.

 FINAL STAGE III

Finally smaller increments of powder again are incorporated, so that the desired
consistency is detained. The phosphoric acid attacks the outside of the powder particle
forming a crystalline matrix of phosphate compounds, and traps the un-dissolved powder
as the cement sets.

 Three critical factors must be considerer when working with zinc phosphate cement:
 Solubility
 Strength
 Setting time
 Proper consistency(strung up about ½ to
Divide into six increments
¾ inch at separation

Strung up more than ¾ inch without seperation

(too think for cementation)
 Mixing Time :1.5 to 2 minutes
 Setting Time:2.5 to 8 minutes
 Working Time:5 minutes
 FACTORS INFLUENCING WORKING TIME AND SETTING TIME

 POWDER, LIQUID RATIO

 Working time and setting time can be increased by reducing the powder,
liquid ratio if not it effects on physical properties and compressive
strength of cement.

 RATE OF POWDER INCORPORATION

Introduction of small quantity of powder in to the liquid for the first few
increments increases working time and setting time by reducing the
amount of heat generated and permits more powder to be incorporated in
to the mix there fore it is the recommended procedure for zinc phosphate
cement.
 SPATULATION TIME
Operators who prolong the spatulation time are effectively destroying the
matrix that was forming.
THERMAL PROPERTIES

Primary use of zinc phosphate is an insulting base beneath the metallic

restoration. These are good thermal insulators and may be effective in
reducing galvanic effect.

The premature contact of incompletely sets cement with water results in

the dissolution and leaching of that surface, for this reason the use of the
term hydraulic to describe any of the zinc phosphate cement is improper
because they do not harden or set with desirable physical properties when
submerged in water.
MECHANICAL AND BIOLOGICAL PROPERTIES
Compressive strength is as high as 104MPa

Diametral tensile strength of 5.5MPa

Making it relatively strong and stiff as compared with other cements

It has low solubility in water

Phosphoric acid in liquid makes mixture more acidic and therefore cytotoxic
when a prostheis is luted with this cement on prepared tooth .
 Advantages
Most popular for cast restorations
Adequate strength
Reasonable working time
Excess material can be easily removed
Acceptable effect over the dental pulp
Manipulation less critical than other cements.

 Disadvantages

Pulp irritation
Lack of antibacterial action
Brittleness
Lack of adhesion
Solubility in acid fluids
Silicophosphate cement
 Combination of zinc phosphate & silicate cement.
Contains small amounts of mercury compounds.
 Composition:
Silicate glass & minor amount of zinc oxide,13-25% fluoride
Liquid contains 50% phosphoric acid,45% water,4-9% zinc, 2% Al.
 Advantages :
Better & toughness than zinc phosphate.
Fluoride release & degree of translucency.
Lower solubility & better bonding.
 Disadvantages :
Less satisfactory mixing & rheological properties
Leading to higher film thickness & greater potential for pulp
irritation.

Used for cementation orthodontic bands & restoring non vital teeth
ZINC POLYCARBOXYLATE
Developed by Dennis Smith 1968, in an effort to produce cement that could adhere to
tooth structure
They adhere via chelation to dental surfaces are also reduce pulpal problems
associated with low pH of the traditional cements
Zinc poly carboxylate was the first cement system that develops an adhesive bond to
the tooth structure these cements are first to have adhesive bond to the hard tooth
structure.
In liquid the Phosphoric acid is substituted by an acid functional polymer forming the
matrix
As they are less acidic hence they do not irritate pulp
The strength is almost same as zinc phosphate cement

They are used for

 Cementing cast metal restorations
 Directly cementing orthodontic brackets on the tooth
 They can also be used for temporary filling
 Cavity base, cavity liners
 COMMERCIAL NAMES
Poly f (DENTSPLY)
HARVARD CC
CARBCO (VOCO)
CERMCO, ”P.C.A”

 DISPENSING
Generally supplied as a
Type A powder liquid
Type Bwater settable powder
COMPOSITION
 POWDER
-Zinc oxide – Main ingredient
- Stannous oxide –Replaces magnesium oxide
- Silica, Alumina or Bismuth - Filler
- Stannous fluoride – 4.5% improves the manipulation
,characteristics, strength.
-Sodium fluoride - 1% Anticariogenic property
LIQUID
- Aqueous solution of Polyacrylic acid
- Co-polymer of acrylic acid
- Other carboxylic acid ( itconic acid) – stabilizes the liquid
When we mix the powder and liquid

Surface of the powder particles are dissolved by the acid

present in liquid

Results in release of zinc, magnesium, strontium ions

These binds and cross link the carboxyl groups.

Result is a crosslinked polycarboxylate matrix phase

encapsulating the unreacted portion of the particles
The hardened zinc polycarboxylate cement is an amorphous gel matrix in
which unreacted powder particles are dispersed.

The pH of the cement liquid is initially slightly less acidic than that of
zinc phosphate cements but it is till very low (1.7)
 MIXING TIME:30 to 60 Seconds
 WORKING TIME:2.5 minutes
 SETTING TIME:6 to 9 minutes
MANIPULATION
 The powder liquid ratio is about 1.5 by weight.

 It should be mixed on a nonabsorbent surface(glass slab)

Liquid component should not be refrigerated (as its is viscous)
The liquid should be dispensed just before use because the water in the liquid
evaporates quickly ,which raises its viscosity .

The powder should be rapidly incorporated with liquid.

A cement must be used before it looses its glossy appearance as it indicates free
carboxylic acid groups are still present for good bonding to the tooth .

A dull looking mixture means insufficient carboxyl group are present for bonding to the
calcium in the tooth
 CONTROL OF WORKING TIME

The working time is much shorter than that for zinc phosphate
cement ,2.5versus 5 minutes.

A cool slab lengthens the working time for zinc carboxylate

cement,although it causes the polyacrylic acid to thicken,which
hinders mixing.

Refrigerating the powder is useful because it retards the reaction

without raising the viscosity of the liquid.

Rapid spatulation and fast seating will reduce the viscosity of the
polycarboxylate cement to ensure complete seating.
MECHANICAL AND BIOLOGICAL PROPERTIES

 Compressive strength – 55 -67 Mpa

Tensile strength –slightly higher than ZnPO4

Modulus of elasticity -2.4 – 4.4 Gpa (less

stiffer& less brittle than ZnPo4

Low soluble in oral fluids than ZnPO4

Excellent biocompatibility with pulp

 Advantages :
Low level of irritation
Good adhesion to tooth substances & alloys.
Good strength ,solubility & film thickness
compare to zinc phosphate.
 Disadvantages

Need for accurate proportion, more critical

manipulation
Lower compressive strength & greater viscoelasticity than
zinc phosphate.
Short working time & need clean surface to use
adhesion potential (technique sensitive).
ZINC OXIDE EUGENOL
Extensively used in dentistry
since 1890’s .
Least irritant of all the dental
materials.
Poor strength when compared
to zinc phosphate.
It has sedative effect on
exposed dentin.
 CLASSIFICATION
ADA SPECIFICATION NO 30 It has listed 4 types:

Type I Used for temporary restoration

Type II Used for Long Term cementation of

fixed prosthesis

Type III Temporary Filling/ Thermal

insulating base

Type IV Intermediate Restorations and

Cavity liners

Phillips’ Science of Dental Materials First south asia edition

COMMERCIAL NAMES

1. Unmodified Tempac -
Cavitic -
Tempbond

2. EBA alumina Modified Opoton

alumina
EBA

3. Polymer Modified Fynal

IRM

4. Non-eugenol -Neogenol
Freegenol
ZINC OXIDE EUGENOL:
Powder:
Zinc oxide: 69.0% - Principal ingredient
White rosin: 29.3% - To reduce the brittleness to set cement.
Zinc stearate: 1.0% - Accelerator, Plasticizer.
Zinc Acetate: 0.7% - Accelerator improves strength.
Magnesium oxide: Added in some powders, acts with eugenol in a similar manner as
Zinc oxide.
Liquid:
Eugenol: 85.0% - Reacts with Zinc oxide
Olive oil – 15.0% - Plasticizer
• MODIFIED ZINC OXIDE EUGENOL CEMENTS:

EBA – Alumina modified cements:

Powder:
Zinc oxide : 70%
Alumina: 30%

Liquid:
EBA – 62.5%
Eugenol – 37.5%

• POLYMER RE-INFORCED ZINC OXIDE EUGENOL CEMENT:

Powder:
Zinc oxide;
Finely divided natural or synthetic resins.

Liquid:
Eugenol:
Acetic acid: accelerator
Thymol: Antimicrobial agent
It involves chelation of two eugenol molecules, with one zinc ion to form
Zinc eugenolate.

The reaction is as follows:

1st reaction
Hydrolysis of Zinc oxide to its hydroxide.
Zinc oxide + H2O  Zn (OH) 2

2nd reaction
Chelation:
Zn (OH) 2 + 2HE  ZnE2 + 2H2O
(Base) (Acid) (Salt)

Zinc Hydroxide Eugenol Zinc Eugenolate

The chelate forms an amorphous gel that tends to crystallize imparting
strength to the set mass.
This reaction proceeds very slowly in the absence of the moisture. When
the mixed material contacts water, however, setting is often
completed within a few seconds.
Setting time: 4 – 10 minutes.
 MANIPULATION
 P/L 4:1 to 6:1
 For temporary cementation or for provisional restoration ,powder is often incorporated
into a dispensed amount of liquid until a suitable consistency is achieved for the operation
at hand.

 A considerable amount of powder can be incorporated into the liquid by heavy spatulation
with a stiff spatula.

 More powder incorporated,the stronger the cement and the more viscous the mixed
cement
 MECHANICAL AND BIOLOGICAL PROPERTIES
 Film thickness - 25-75 um
Compressive strength - 35-55 MPa
Tensile Strength - 4 MPa
Water immersion reduces the mechanical
properties due to loss of eugenol.
Mechanical retention of crowns of ZOE
cement is less than Zinc phosphate cements.
 Advantages:

Minimal pulpal reaction.

Good sealing properties
Strength adequate for lining material & luting single
restoration & retainers, with good retention form.

Disadvantages:

Hydrolytic breakdown under exposure to oral fluids

Inflammatory reaction in soft tissue
potential allergic response
Minimal mechanical properties for luting
May soften & discolor
 GLASS IONOMER CEMENT
 GIC is the generic name for materials based on the reaction of glass powder and polyacrylic
acid.

 The cements were developed in the 1970s to improve clinical performance compared with
silicate cements and to reduce the risk of pulp damage.

 The use of polyacrylic acid makes GIC capable of bonding to tooth structure.

 GIC is considered superior to many types of cements because it is adherent and translucent .

 Various formulas are available depending on the intended clinical application.

 Water –soluble polymers and polymerizable monomers have been replacing part of the
liquid content .

 Particles of metal,metal-ceramic and ceramic have been added to some products to

enhance mechanical properties.

 GICs have been used for the esthetic restoration of anterior teeth eg,class III and V
sites,as luting cements and intermediate restoration,as pit and fissure sealants,liners
and bases and as a core buildup materials.
 The GICs are classified :-

TYPE 1 : luting crown ,bridges and orthodontic

brackets.

TYPE IIa : esthetic restorative cements

TYPE IIb : reinforced restorative cements

TYPE III : lining cements,base

PHILIPS SCIENCE OF DENTAL MATERIAL (SOUTH ASIA EDITION)

 CHEMISTRY AND SETTING:

 It is essentially the same for all three types,with variations in powder composition
and particle size to achieve the desired function.

 The consistency of the mixed GIC varies widely among manufacturers ,from low to
very high viscosity as influenced .by their use of various particle size distributions
and the P/L ratio.

 Larger particles(50µm) are used for the various restorative indications and finer glass
particles (15µm)are used for cementing.

Phillips’ Science of Dental Materials First south asia edition

POWDER
 Silica - 41.9
 Alumina- 28.6
 Aluminium fluoride – 1.6
 Calcium fluoride – 15.7
 Sodium fluoride- 9.3
 Aluminium phosphate- 3.8
The ratio of alumina to silica is the key to their reactivity with polyacrylic acid.
Barium,strontium,or other higher atomic number metal oxides are added to the glass to
increase the radiopacity .
The silica glass is melted at temperature between 1100°C and 1500°C ,depending on the raw
materials and overall composition.
The glass is ground into a powder with particles ranging from less than 15µm to about 50µ
,depending on the indication.

Phillips’ Science of Dental Materials First south asia edition

LIQUID COMPOSITION

 Aqueous solution of polyacrylic acid(above 40% to 50%) were used,but

such liquids were viscous and had a short shelf life because of gelation.

 The liquids are copolymers of itaconic ,maleic or tricarboxylic acids.

 Tartaric acid is a rate controlling additive in the GIC liquid that allows a
wider range of glasses to be used ,improves handling properties
,decreases viscosity ,lengthens shelf like before gelling of the liquid
occurs ,increases working time ,and shortens the setting time.
 When the powder and the liquid are mixed for a GIC ,the acid starts to
dissolve the glass, releasing calcium ,aluminum sodium and fluoride ions.

 Water serves as reaction medium.

 The polyacrylic acid chains are then cross linked by calcium ions are
replaced by aluminum ions.

 Sodium and fluorine ions from the glass do not participate in the cross
linking of the cement.

 Some of the sodium ion may replace the hydroden ions of carboxylic
groups,and fluorine ions are dispersed within the cross linked(matrix)
phase of the set cement.
 The cross linked phase becomes hydrated over time as it matures.

 The undissolved portion of glass particles is sheathed by a silica rich gel

that is formed on the surface of the glass particles.

 This the set cement consists of undissolved glass particles with a silica
gel coating embedded in an amorphous matrix of hydrated calcium
aluminum polysalts containing fluoride.
STRUCTURE OF SET GIC
Photmicrograph of a set GIC showing unreacted particles surrounded by
the continous matrix
MANIPULATION

 The P/L ratio recommended by the manufacturer should be followed .

 A paper pad or cool ,dry glass slab should be used.
 Normally half of the powder is mixed into the liquid for 5 to 15 seconds ,the rest of
the powder is then quickly added and mixed by folding the cement on itself until a
uniform ,glossy appearance is achieved.
 Mixing time should not exceed 45 seconds
 Glossy appearance indicates presence of unreacted particles.
 Dull appearance indicates that the acid has reacted too much with glass particles for
good bonding

Phillips’ Science of Dental Materials First south asia edition

 They are supplied in 2 bottles or capsules containing preproportioned powder
and liquid .
 A triturator is used to mix the powder and liquid after the seal between the
powder and liquid has been broken.
 Capsule contains a dispensation tip that facilitates direct injection of the mix
into the prepared tooth cavity or onto a fixed prosthesis for bonding .
 It elicit greater pulpal reaction than ZOE cement but less than zinc
phosphate cement.
 GIC luting agents pose a greater pulpal hazard than GIC restorations
when the GIC is mixed with a low P/L ratio because the pH remains
acidic longer.
 With any GIC a protective liner should be used eg calcium hydroxide if
preparation is closer than 0.5mm to the pulp chamber.
 Metal Reinforced GIC
 Metallic fillers have been incorporated in the GIC to improve their fracture toughness and stress
bearing capacity .

 The metallic fillers are derived from silver alloy powder or particles of silver sintered to glass
that make the cement grayish and more radiopaque,these metal reinforced GIC are called alloy
admixture and CERMET.

 The adhesion and fluoride release from the metal re-inforced GICs are very useful for core
builups of teeth to be restored with cast crowns and for restoratives on occlusal surfaces of
primary molars.

 These are limited in use as an alternative to amalgam or composite for posterior restorations.

Phillips’ Science of Dental Materials First south asia edition

 HIGH VISCOSITY GIC

 ART is a preventive and restorative caries management concept developed for

dentistry in regions of the world that do not have an infrastructure with electricity
or piped water system.
 GIC which releases fluoride and bonds chemically to tooth structure ,is the natural
choice of material for these situations.
 Initial results of using conventional GIC have proven the feasibility for ART ,which
has led to the development of HIGH VISCOSITY GIC.
 These have smaller glass particles size and use higher p/l ratio
 They exhibits excellent packability for better handling characteristics .
 They are also used for core buildups ,primary tooth fillings,non-stress-bearing
restorations.and intermediate restoration in general practices.
 Encapsulated packaging of the high –viscosity GICs is convenient
 CLINICAL MANIPULATION

 Clinical steps in the ART procedure with high-viscosity GICs are as follows:

 1)isolating the tooth with cotton rolls

 2)accessing the carious lesion with hand intrument.
 3)removing the soft tissue with an excavator.
 4)using weak acid to prepare the tooth and enhance chemical bonding
 5)placing the high viscosity GIC using finger pressure.
RESIN MODIFIED GIC (HYBRID IONOMER)

 Water –souble methacrylate –based monomers have been used to replace

part of liquid components of conventional GIC results in a group of
materials called resin –modified glass ionomer cement/hybrid ionomer
cement
 CHEMISTRY AND SETTING

 The monomers can be polymerized by a chemical or light activation or

both and the GIC acid base reaction will occur along with the
polymerization.
 Some hybrid ionomer cements also contain nonreactive filler
particles,which lengthens the working time,improves early strength ,and
makes the cement less sensitive to moisture during setting.
 CHEMISTRY AND SETTING:-
 Liq contains a water solution of polyacrylic acid,HEMA, and polyacrylic
acid modified with methacrylate.
 The powder component contains fluoroaluminosilicate glass particles of
conventional GIC plus initiators such as camphorquinone,for light curing
or chemical curing.
 The acid –base reaction begins upon mixing and continues after
polymerization at much a slower rate than for conventional GICs
because less water is present and the reaction is much slower in the
solid phase than in the liquid phase.

 The bonding mechanism is same as the conventional GIC

 The clinical manipulation includes liners,fissure sealants,base

materials,core buildups,restorative,adhesives for orthodontic
brackets,repair materials for damaged amalgam cores or cusps and
retrograde root filling materials.

 For any indications ,surface conditioning of the tooth with mild acid is
essential for bond formation.
Calcium aluminate GIC

 A hybrid with a composition

between that of calcium
aluminate and GIC for luting
fixed prosthesis is new addition to family of GIC.
It is made by sintering the mixture of high-purity aluminum oxide and calcium
oxide (1:1molar ratio)to create monocalcium aluminate.
The powder acts as base and water as a weak acid.
It is also known as hydraulic cement
 Powder: calcium aluminate ,polyacrylic acid,tartaric acid,strontium-fluoro-
alumino-glass,and strontium fluoride.
 liquid: 99.6%water and 0.4% additives for controlling setting.

COMPOMERS
CHEMISTRY AND SETTING

 Compomers are one paste ,light cure materials for restorative applications,although
liquid powder system for luting application are available .
 These water free material contain nonreactive inorganic filler particles ,reactive
silicate particles ,sodium fluoride ,and polyacid modified monomers such as diester of
2-hydroxyl methacrylate with butane carboxylic acid and photoactivators.
 Setting is initiated by photopolymerixation of the acidic monomer.
 Compomer cements are sensitive to moisture and are packaged to protect against
moisture absorption ,even though their acid base reaction is slow.
 For powder liquid compomer producs,the powder contains strontia-
alumina-fluorosilicate glass,metallic oxides,and initiators.

 The liquid contains polymerizable methacrylate /carboxylic

monomers,multifunctional acrylate monomers and water.

 Depending on the initiators the material can be chemically cured,light

cured,or dual –cured to augment the slower acid –base reaction
 BONDING MECHANISM
 It requires a dentin bonding agent prior to their placement as the do not
contain water which could make them self adhesive.

 Bond strength of one paste is similar to or higher that hybrid ionomer.

 The p/l compomer cements for luting are self adhesive ,as water in the
liquid makes the mixture acidic like hybrid ionomer.
MANIPULATION

 The tooth structure should be etched prior to the application of the dentin
bonding agent and the compomer .
 Compomers are finished just like resin composites.

 Compomers luting system are indicated for cementing prosthesis with

metallic substrate.
 The cement mixture is placed only on the prostheses with metallic substrate
PROPERTIES OF GIC
 CALCIUM HYDROXIDE CEMENT
 In 1920 Hermann introduced Ca(OH)2 to promote healing in many clinical situations.

 It is a white odourless powder with the chemical formula

Ca(OH)2 and a molecular weight of 74.08 (Farhad & Mohammadi 2005).
 It has low solubility in water , which decreases with a rise in temperature (Siqueira & Lopes 1999).
It has been demonstrated that the dissociation coefficient of Ca(OH)2 controls the slow release of
both calcium and hydroxyl ions (Rehman et al. 1996).

 This low solubility is a useful clinical characteristic as an extended period is necessary before it
becomes solubilized when in direct contact with fluids from vital tissues . The pure
powder has a high pH (approximately 12.5–12.8) and is insoluble in alcohol .
 The material is chemically classified as a strong base, its main actions come from the ionic
dissociation of Ca2+ and OH) ions and their effect on vital tissues, generating the induction of hard-
tissue deposition and being antibacterial.

Z. Mohammadi1 & P. M. H. DummerProperties and applications of calcium hydroxide in endodontics

and dental traumatology International Endodontic Journal, 44, 697–730, 2011
 On Vital dentin
Considerably reduces the permeability of exposed dentin
for penetration of bacterial components towards the pulp.
This may be due to
Coagulation of proteins in dentinal
tubules
Due to secondary dentin formation
It has an antibacterial effect
 On Carious Dentin
Ca(OH)2 has a strong antibacterial effect on the
contaminated soft carious dentin.
 ON EXPOSED PULP
Low grade irritation due to coagulative necrosis
caused by Ca(OH)2 leading to hard tissue
differentiation in the pulp to calcific barrier
formation.
MECHANISM OF ACTION OF CALCIUM HYDROXIDE

GROSSMAN ENDODONTIC PRACTICE, 12TH EDITION

DIFFERENT FORMS OF CALCIUM
HYDROXIDE AVAILABLE
 DRY POWDER
Dry powder of Ca(OH)2 medicinal grade. Free from
impurities and contaminants is available. The powder could be
supplied as such or mixed to a paste with either distilled water
or normal saline. Mixing with water or ortho ethoxy benzoic
acid is avoided as the reaction is too fast for convenient
clinical use.
LIQUIDS
They are supplied in bottles. Resinous solution of Ca(OH)2
are used as liners. The combination or resin film with alkaline
Ca(OH)2 provides a protective film having better physical
integrity as well as chemical neutralizing capacity for acids.
 SETTING PASTE
1. Chemically Activated Ca(OH)2 paste system
Base
1) Calcium hydroxide – 51%
2) Zinc oxide -9.23%
3) Zinc Stearate – 0.29%
4) Ethylene Toluene Sulphonamide -39.48%
CATALYST
Titanium oxide – 45.1%
Calcium Tungstate -15.2%
Barium sulphate – 4%
Glycol salicylate – 35.7%
 Visible light activated Ca(OH)2 – Single paste
system.
CaOH2
BaSO4
UDMA Resin
Camphorquinones.

 SLOW SETTING Ca(OH)2 Pastes.

Root Canal Sealer materials
Ca(OH)2 can be used as a sealer to coat the Wound of the pulp
space and form a hermetic seal
Ex – Calcibiotic
Root Canal Sealer paste (CRCS Paste)
Containing – ZOE, Ca(OH)2
 VEHICLES
 When CaOH2 powder is mixed with a suitable vehicle a paste is
formed.
There are three main types of vehicles:
1. Water-soluble substances such as water, saline,
anaesthetic solutions, carboxymethylcellulose,
methylcellulose and Ringers solution.

2. Viscous vehicles such as glycerine, polyethyleneglycol (PEG) and propylene glycol.

3. Oil-based vehicles such as olive oil, silicone oil,
camphor (the oil of camphorated parachlorophenol),
some fatty acids (including oleic, linoleic, and isostearic
acids), eugenol.
 APPLICATIONS
 In Direct and Indirect pulp capping
 Liners in deep cavity preparations
 In apexification procedures
 Intracanal medicaments
 As a Base
 As a prevention and treatment of resorption
 Repair in perforations
 Root canal sealer.

Z. Mohammadi1 & P. M. H. DummerProperties and applications of calcium hydroxide in endodontics

and dental traumatology International Endodontic Journal, 44, 697–730, 2011
 MINERAL TRIOXIDE AGGREGATE CEMENT
 Mineral Trioxide Aggregate (MTA) was introduced by Mohmoud Taorabinejad at Loma Linda
University, California, USA in 1993 and was given approval for endodontic use by the U.S.
Food and Drug Administration in 1998. list of commercially available MTA.

Macwan C, Deshpande A. Mineral trioxide aggregate (MTA) in dentistry:

A review of literature. J Oral Res Rev 2014;6:71-4
 Composition and manipulation
 MTA is available in two types based on the color known as gray and white MTA

Table 2: Chemical compositions of GMTA and WMTA [Adapted from Asgary et al. (2005)]

Macwan C, Deshpande A. Mineral trioxide aggregate (MTA) in dentistry:

A review of literature. J Oral Res Rev 2014;6:71-4
 Torabinejad et al. (1999) and Schmitt et al. (2001) advocated that the powder
water ratio for MTA should be 3:1(P: W). Mixing can be done on paper pad or on a
glass slab using a plastic or metal spatula to achieve putty like paste consistency.
This mix should be cover with moistened cotton pellet to prevent dehydration of
mix.
 Immediately after mixing MTA has a pH of 10.2. After 3 hours of setting the pH
increased to 12.5. The pH of set MTA is almost similar to calcium hydroxide.
Initial setting time about 2 hours and 55 minutes and 2 hours and 20 minutes for
grey MTA and white MTA, respectively.
 MTA being hydrophilic requires moisture to set. Presence of moisture during
setting improves the flexural strength of the set cement. Therefore, it is
advised to place a wet cotton pellet over the MTA in the first visit followed by
replacement by a permanent restoration at the second visit.
 The long setting time is one of the drawbacks of MTA because of it should not be
applied in 1 visit. Inter-appointment moist cotton palate is required till the final
setting of MTA.

Macwan C, Deshpande A. Mineral trioxide aggregate (MTA) in dentistry:

A review of literature. J Oral Res Rev 2014;6:71-4
 To mix MTA p/l 3:1 is dispensed on glass slab with a drop of liquid from kit next to
powder ,a stiff metal spatula should be used to incorporate the powder gradually into
the liquid until a putty like consistency is reached .
 Thorough mixing and repeated spatulation should be performed ,the mixed material
can be formed and rolled into “log” with gloved fingers then spatula can be used to cut
off small sections for insertion in a root end filling or a perforation site .
 A spatula ,a small amalgam carrier or a condenser is commonly used to transport the
MTA into surgical location .

 Phillips’ Science of Dental Materials First south asia edition

 Applications

•Pulp capping
•Partial pulpotomy
•Perforation repair - Apical, lateral, furcation
•Resorption repair - External and internal
•Repair of fracture - Horizontal and Vertical
•Root end filling
•Apical barrier for tooth with necrotic pulps and open apex
•Coronal barrier for regenerative endodontics
•Root canal sealer

Macwan C, Deshpande A. Mineral trioxide aggregate (MTA) in dentistry:

A review of literature. J Oral Res Rev 2014;6:71-4
 Mechnical properties
 Compressive strength

Torabinejad M, et al. (1995) studied physical properties of MTA and found that compressive
strength at 24 hours 40.0 MPa and at 21 days 67.3MPa; and in comparison between GMTA and
WMTA result showed that compressive strength of Gray MTA > White MTA.

 Solubility

The set MTA shows no signs of solubility. But, if more water is used during mixing the MTA it may
results into increased solubility. Buding (2008) ]found that the set MTA when exposed to water it
releases calcium hydroxide (CaOH 2 ). CaOH 2 might be responsible for its cementogenesis-inducing
property. During setting reaction if mix is exposed to acidic environment it does not interfere in the
setting.

Macwan C, Deshpande A. Mineral trioxide aggregate (MTA) in dentistry: A review of literature. J Oral
Res Rev 2014;6:71-4
Resin cements
The success of attaching unfilled resin to etched enamel gave rise to the concept of
using resins to bond fixed prosthesis to abutments.

 Applications
 1.cementation of crown and bridges
 2.cementation of porcelain veneers and inlays
 3.For bonding of orthodontic brackets to acid etched enamel

Phillips’ Science of Dental Materials First south asia edition

Supplied as ;
Powder/liquid system
Two paste system
Single paste system
Dual cure –two paste system

Commercial names
Porcelite dual cure
Panavia x
Composition
Powder
Resin matrix
Inorganic fillers
Coupling agent
Chemical or photoinitiators and activators
Liquid
Methyl methacrylate
Tertiary amine
Polymerization
Chemically by peroxide amine system
Or by light activation
Or by both chemical and light activation (dual cure)

.Phillips’ Science of Dental Materials First south asia edition

MANIPULATION

 Liner is important when the thickness of the remaining dentin is less than .5mm as the
monomeric component is irritating to the pulp.

 Chemically cured resin cements are suitable for all types of restorations.
 They are supplied as powder liquid or 2 paste which are mixed on paper pad for 20 to 30
seconds.
 Chemical activation is slow and provides extended working time and strength increases as the
chemical process continues.

Phillips’ Science of Dental Materials First south asia edition

 Dual cure cements require mixing similar to that for the chemical cure system
 Static mixing and trituration of capsules have largely replaced the need for hand mixing.
 Curing proceeds slowly until the cement is exposed to the curing light at which point the cement
hardens rapidly.

 They should not be used with light transmitting prosthesis thicker than 2.5 mm anything thicker than
2.5 should be bonded with chemical cure cement
 Removal of excess cement may be done after seating of prosthesis.

Phillips’ Science of Dental Materials First south asia edition

REFERENCES
1.Sturdevant’s Art and Science of Operative Dentistry A South asia edition
2.Sturdevant’s Art and Science of Operative dentistry fourth edition
3.Phillips’ Science of Dental Materials 11th edition
4.Phillips’ Science of Dental Materials First south asia edition
5. Craig and John. M: Restorative Dental Materials 12th edition.
6.Dental Materials and their Selection Williams O'Brien, Fourth edition
7.Z. Mohammadi1 & P. M. H. Dummer Properties and applications of calcium
hydroxide in endodontics and dental traumatology International Endodontic
Journal, 44, 697–730, 2011
8.Grossmans endodontic practice 12th edition
9.Macwan C, Deshpande A. Mineral trioxide aggregate (MTA) in dentistry: A
review of literature. J Oral Res Rev 2014;6:71-4