FIXED PARTIAL DENTURE

CEMENTATION AND
MAINTAINENCE

Presented by
Dr Shubhangi Agrawal
IInd Year PG
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 CONTENT
 Introduction
 Terminologies
 History of cement
 Classification of cement
 Abutment prosthesis interface
 Bonding mechanism
 Requirements of luting cement
 Luting cements
 Zinc oxide eugenol
 Zinc phosphate
 Zinc polycarboxylate
 Glass ionomer cement
 Resin modified glass ionomer cement 2
 Resin cement
 Cementation of different types of resin cement
 NX3 Nexus (Kerr)
 Variolink (ivoclar vivident)
 Panavia (kuraray)
 Special consideration
 Cementation of gold inlay
 Cementation of all ceramic
 Cementation of veneers
 Cementation of lumineers
 Maintainence of FPD
 Post cementation instruction
 Use of different interdental cleaning aids
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  Dental floss
 Interdental brushes
 Oral irrigators
 Review of literature
 Conclusion
 References

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INTRODUCTION

5
 Luting is derived from latin word “lutum” that means mud.

 The word luting implies the use of a moldable substance to

seal a space or to cement two components together.

 One of the main purposes of luting is to fill and seal the space
completely.

 The current approach for cementing prostheses or appliances

is to use adhesive technology, which invoIve placement of a
third material (a luting agent) that flows within the rough
surfaces and sets to a solid form within a few minutes.

 Also improves the retention of the prosthesis.

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TERMINOLOGIES

7
1. Cement-
 A binding agent used to firmly unite two approximating objects;
 A material that, on hardening, will fill a space or bind adjacent
objects

2. Cementation-
 The process of attaching parts by means of cement;
 Attaching a restoration to natural teeth by means of a cement

3. Luting agent-
 Any material used to attach or cement indirect restorations to
prepared teeth

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HISTORY

9
First used dental cement-silicate cement
1871-silicate cement (fletcher)
1879-zinc phosphate cement(otto hoffman)
1942-zinc oxide eugenol(chrisholm)
1947-methyl methacrylate resins
1960-composites
1972-glass ionomers(wilson and kent)
1995-Resin modified glass ionomer cement
2004-self etching resin cement
2009-ceramir C and B

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CLASSIFICATION OF
CEMENT

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12
Classification of cements based on general
composition

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 Classification based on Application (According to
ADA)
TypeI : Luting agents
– Type I : Fine grain for cementation and luting
– Type II : Medium grain for bases, orthodontic purposes

Type II : Restorative application

Type III : Liners or base applications

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ABUTMENT-PROSTHESIS
INTERFACE

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 When two relatively flat surfaces are brought into contact,
analogous to a fixed prosthesis being placed on a prepared
tooth, a space exists between the substrates on a microscopic
scale.

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 BONDING MECHANISM
1. Non-adhesive Luting.
2. Micromechanical Bonding.
3. Molecular Adhesion.

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Non-adhesive Luting

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Micromechanical Bonding.

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Molecular Adhesion

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REQUIREMENTS OF LUTING
CEMENTS

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 Adhesion to restorative material .
 Adequate strength to resist functional forces.
 Lack of solubility in oral fluids.
 Low-film thickness
 Biocompatibility with oral tissues
 Possession of anticariogenic properties.
 Radio-opaque.
 Relative ease of manipulation
 Esthestic/ color stability.

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 LUTING CEMENTS
 Zinc phosphate cement
 Zinc polycarboxylate cement
 Glass Ionomer cements
 Zinc oxide eugenol cements
 Resin cements
 Resin modified glass ionomer

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ZINC OXIDE EUGENOL

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 These are obtundent, chemically neutral, physically low
strength, thermal insulating opaque restorative materials
having long history.

Classification
According to ADA specification No. 30, they are classified
into 4 types according to their uses
 Type I: Temporary cementation compressive strength <35
Mpa

 Type II: Permanent cementation compressive strength >35

MPa

25
 Type III: Temporary restoration compressive strength >25
Mpa

 Type IV: Cavity lining compressive strength >5 Mpa

Trade names
 Tembond (Kerr), Fynal(Caulk)

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1.Unmodied ZnOE cement

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Zinc oxide−based paste-paste temporary
cements.
A, A two-tube system for hand mixing. B, A
dual-cartridge system for
hand mixing. C, A dual-cartridge system with
static mixing
28
2.Resin modified zinc oxide eugenol cements:
Natural or synthetic resins (methyl methacrylate resin) are
added into the powder to increase the strength of the cement

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30
3. Ethoxy benzoic acid (EBA) alumina cement
Fused alumina is added to the powder and orthoethoxy
benzoic acid into the liquid to enhance the strength of the cement

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4.Noneugenol cements
Since direct contact of eugenol can cause irritation to soft
tissues, eugenol is completely replaced with material like
vanillate esters (hexyl vanillate) and orthoethoxy benzoic acid.

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33
SETTING REACTION
 ZnO + H2O → Zn (OH)2
 Zn(OH)2 + 2 HE → ZnOE2 + 2H2O

PROPERTIES
1.Biological Eugenol has an obtundent effect on the
Properties pulp. It has bacteriostatic property.

2.Rheological The cement material does not change its

Properties viscosity quickly during its placement into
into the prepared cavity.
3.Mixing and M.T. is 1-1.5 mn
Setting time S.T. is 4-10 mn
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4.Film thickness less than 25 μm

5. Solubility and Zinc oxide eugenol cement 0.04%

Disintegration Resin modified cement 0.05%
EBA alumina cement 0.03%
6. Mechanical ZOE cement resin modified EBA
properties unmodified cement cement
C.S. 3-40MPa 55MPa 50MPa
T.S. 0.3-6MPa 4MPa 4MPa
M.O.E 220-5400 2500 5000
Mpa MPa Mpa
P/L
ratio 3-4:1 5-6:1 7:1
7. Retention By physical means
8.Thermal Very low thermal conductivity
properties
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CEMENTATION PROCEDURE
 Mixing is started by adding two bulk
increments one after the other into the
liquid and mix is thoroughly spatulated.
Then small increments are added one
by one until required consistency is achieved. For luting
consistency, the mix should be thinner and have a creamy
appearance.

 The mix is applied to the seating surface of the restoration and

then placed on the prepared tooth. The restoration is held on
the tooth under pressure until cement sets. The excess is
carefully removed.
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ADVANTAGES
Obtundent–suitable for use to relieve postoperative sensitivity,
pulp protection from thermal, chemical and electrical insults.
Good marginal sealing properties due to low dimensional
changes during setting.
Resists marginal leakage.
Sufficient strength for cementation–only for modified ZnOE
cement.

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DISADVANTAGES
 Low compressive strength of unmodified cement is inadequate
for permanent cementation (however, modified cements can
be used for intermediate restorations, cement bases and
permanent cementations).
 Eugenol is a solvent for resins. Hence, contra-indicated to use
as base for composite resins.
 Eugenol leaches and may diffuse causing discolouration, if
used as base for glass-ionomer cements.
 Does not chemically bond with dentin, enamel or metallic
restorations.
 Does not help to form reparative dentin.
 Not anticariogenic

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INDICATION
Zinc oxide eugenol cements
Type I–temporary cementation
Type II–permanent cementation
Type III–temporary restorations
Type IV–cavity liners
These cements can also be used as pulp capping agents and
root canal sealants

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CONTRAINDICATION
Zinc oxide eugenol cements are contraindicated for using in
contact with
Composite resins (eugenol can dissolve the resin and
make it soft)
GIC restorations (leaching eugenol can diffuse and cause
discolouration).

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ZINC PHOSPHATE

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42
 This cement is the oldest luting cement available, having a
long track record which can be used as a standard for
comparing new cementation materials.
Alternative names
 Zinc cement
 Zinc improved cement
 Zinc oxyphosphate cement
 Crown and bridge cement.

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According to ADA specification, No. adapted in 1935, zinc
phosphate cements can be classified into two types
Type I: Fine grain, used as luting cement (film thickness is <
25 mm)
Type II: Medium grain, used as a thermal insulting
base/intermediate restorative material (film thickness is < 40
mm).

Trade names
Tenacin (Caulk), Flecks(Mizzy)

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COMPOSITION

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46
SETTING REACTION

PROPERTIES
1.BIOLOGICAL Zinc phosphate cement is quite irritant to the
PROPERTIES pulp, Particularly when used as cement base
material.
2.RHEOLOGICAL Mixing time: 1–1.25 min
PROPERTIES Setting time: 5.5 min
3.CONSISTENCY 30–35 mm (thin strand like consistency
4. FILM
THICKNESS 25-30mm
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5.P/L ratio 2.8 gm/ml for luting consistency
6.COMPRESSIVE
STRENGTH 80–100 MPa
7.TENSILE
STRENGTH 5.5 MPa
8.MODULUS OF
ELASTICITY 14,000 MPa
9.THERMAL It is a good thermal insulator and is suitable to
PROPERTIES be used as a thermal insulating base.
10. ADHESION This does not form chemical bonding with
PROPERTY enamel or dentin. The retention of cemented
restoration depends on the mechanical inter
locking of the set cement with the roughness
of the surface of the cavity and the inner part
of the alloy restorations.
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USES
It is primarily used as permanent cementation material to fix
preformed restorations or castings (inlays, crowns, bridges, etc.).
Used to fix orthodontic bands.
Used as a thermal insulating high strength base.
It is also used as temporary or intermediate restorative material.

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ADVANTAGES
It has adequate compressive strength and modulus of elasticity
to resist fracture and deformation/under stress.
Easy manipulation procedure, and less critical technique.
Sets sharply to relatively hard mass from a fluid consistency.
Lower solubility than silicate cement.

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DISADVANTAGES
Pulpal irritation due to its high initial acidity. Hence should not
be placed directly on exposed dentin.
Lack of anticariogenic property.
It is a brittle cement, poor tensile strength.
Lack of chemical adhesion to the tooth.
Soluble in oral fluids.
Not aesthetic.

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CEMENTATION
 The field must be kept dry during final placement of the
restoration and hardening of the cement.

 The quadrant containing the tooth being restored is isolated

with cotton rolls and a suction device such as a saliva ejector
for the maxillary arch or a Svedopter for the mandibular arch.

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 If the tooth is vital partial protection of the pulp can be
provided by the application of two thin layers of copal cavity
varnish.

 It is applied to the dry tooth with cotton pellets and lightly

blown dry after each application. This partially seals the
dentinal tubules and protects the pulp from the phosphoric
acid

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 Place powder on one end of a glass slab that has been cooled
in tap water and wiped dry. At the center of the slab, measure
out approximately six drops of liquid for each unit to be
cemented.

 Use the spatula to divide the powder into small increments

approximately 3 mm on a side. Move one increment across the
slab and incorporate it into the liquid, mixing it for 20 seconds
across a wide area

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 Continue to add small increments of powder, mixing each for
10 to 20 seconds using a circular motion and covering a wide
area of the slab.

 Check the consistency by slowly lifting the spatula. When the

consistency is right, it will string out about 10 mm between the
spatula and slab before it runs back onto the slab.

 Quickly load the clean, dry restoration with cement. Brush or

wipe cement on the inner surfaces of the restoration

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 Seat the restoration on the tooth and, if it is a posterior tooth
with uniform occlusion, have the patient apply force to the
occlusal surface of the restoration by closing on a plastic wafer

 Anterior crowns and crowns that occlude on only one corner

might become tipped by pressure from the opposing teeth even
on a cementation wafer. In these cases it is better to apply
force with a finger padded by a cotton roll.

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 Check that the restoration is completely seated by palpating a
supragingival margin with an explorer through the soft
extruded cement, or by removing the bite stick and having the
palient close with shim stock between nearby teeth.

 After the restoration is completely seated, keep the field dry

until the cement has hardened.

 No attempt should be made to remove excess cement while it

is still soft. The excess helps protect the margins during
setting.

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 Once the cement has completely set, remove all excess with a
sealer, explorer, and knotted dental floss.

 The entire crevice should be checked with an explorer several

times to insure that all of the cement has been removed.

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ZINC POLYCARBOXYLATE

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 It was the first dental cement which had chemical bonding
with tooth structure (adhesive dental cement) formulated by
Dr. Smith in 1968, while trying to find out a cement which
had strength of zinc phosphate and biological acceptability of
zinc oxide eugenol cements.

Alternative names
 Zinc polyacrylate cement
 Zinc poly C
 Zinc poly F

Trade name
 Durelon (ESPE), Tylok Plus(Caulk)

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61
 COMPOSITION

Liquid
•Polyacrylic acid
•Itaconic acid, tartaric acid Reduce the high viscosities
and copolymers
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 PROPERTIES
1.BIOLOGICAL It has good biocompatibility with pulp. The
PROPERTY effect of polycarboxylate cement on soft and
calcified tissues is found to be mild.
2.RHEOLOGICAL Mixing time 30–45 seconds
PROPERTIES Setting time 6-9 minutes
Film thickness 21– 35 mm.
3.MECHANICAL Compressive strength 55–85 MPa
PROPERTIES Tensile strength 8–12 MPa
Modulus of elasticity 5–6 Gpa
4.ADHESION Polycarboxylate cement displays good
adhesion to enamel and dentin through
calcium chelation (chemical bonding).
5. THERMAL These are good thermal insulating materials and
PROPERTIES can be used as thermal insulating bases.
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6.AESTHETIC These cements cannot be used as anterior
restorative material as the set cement is
opaque due to concentration of unreacted
zinc oxide.

7.P/L RATIO Powder liquid ratio for luting cement =

1.5 gm/ml

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USES
 For cementation of cast-alloy restoration like metallic crowns
and bridges.
 Cementation of porcelain restorations and orthodontic bands
 As thermal insulating bases
 As temporary filling materials.

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ADVANTAGES
 Excellent biocompatibility when pulp is not exposed.
 Chemical bonding to the tooth (enamel and dentin)
 Freshly mixed cement exhibits shear thinning or
pseudoplasticity
 Good thermal insulating materials
 Easy manipulation methods.

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DISADVANTAGES
 Accurate proportioning is required for optimum properties
 Need for a clean surface to utilize adhesion potential
 Shorter mixing and working time
 Low compressive strength than zinc phosphate cement
 Soluble in oral fluids
 Anticariogenic properties, is not good when compared with
silicate or glass ionomer cements
 Does not bond chemically with porcelain or noble metal or
base metal castings.

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CEMENTATION
 Use cotton rolls to isolate the quadrant containing the tooth
being restored. The tooth should be thoroughly clean.

 Following try-in, wash the restoration in water and dip it in

alcohol to remove all contaminants.

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 Sandblast the inside of the casting to insure maximum retention.

 Coat the outside of the casting to be cemented with petroleum to

prevent the cement from sticking where it is not needed.

 Dispense one measure of powder for each restoration to be

cemented.

 Pick up the powder by pressing the measuring stick, scoop

down, into the bottle of powder.

 Scrape off the excess and place the powder on a glass slab or a
special impermeable mixing pad provided with the cement.

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 Express 1.0 mL of liquid from th graduated syringe for each
measure of powder and begin mixing immediately.

 The powder should be incorporated quickly and the

spatulation should be completed within 30 seconds. Because
the liquid has a honey-like consistency, the cement may seem
loo viscous. This is normal.

 Coat the inside of the casting with cement, and place some on
the tooth while the cement is still glossy.

 Place the casting on the tooth with firm finger pressure. Then
instruct the patient to bite on a plastic wafer or a wooden stick.

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 If the cement becomes dull in appearance before the casting is
cemented, remove the cement from the casting and repeat the
procedure.

 Clean the instruments and the slab with water before the cement
has set.

 Remove cement from the casting in the mouth before it becomes

rubbery, or after it has set. Removing the cement while it is in its
elastic, semi-set stage may pull some out from under the margin
of the restoration, leaving a void in the cement near the margin.

 Keep the restored tooth isolated and dry until the cement has set
completely
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GLASS IONOMER CEMENT

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 This cement is termed as glass ionomer cement since the powder
is glass, and the setting and bonding reaction to the tooth involve
ionic bonding.

Alternative names
 ASPA cement, (aluminosilicate polyacrylate cement)
 Glass Polyalkeonates

TYPES OF GLASS IONOMER CEMENTS

 Type I: Luting cements
 Type II: Restorative cements
 Type III: Cavity liners, cement bases
 Type IV: Fissure realants
 Type V: Orthodontic cements
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74
 Type VI: Core build up material
 Fuji VII: Excellent material for prevention of caries, the
world’s first high fluoride non resin containing autocure
GIC.
 Fuji VIII and Fuji IX: These materials are new, high
viscosity GICs launched in 1990s– atraumatic restorative
materials (ART) (also referred as gaediatric or paediatric
materials).
 Pit and fissure sealants

TRADE NAMES
Fuji (GC), Ketacam (ESPE)

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COMPOSITION

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Liquid :
Polyacrylic acid (40%)
Itaconic acid, maleic acid, tricorboxylic acid
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 PROPERTIES
1.BIOLOGICAL • The effect of GIC on soft and calcified
PROPERTIES tissues is found to be mild
• Anticariogenic
• Bioactivity (osseointegration)
• Direct bonding with tooth

2.RHEOLOGICAL Mixing time:30 seconds

PROPERTIES Working time:1½ minutes
Setting time:6-9 minutes
Film thickness-25-30mm

3.MECHANICAL C.S.-90-140MPa
PROPERTIES T.S.-6-7MPa
M.O.E-7-8GPa
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4.ADHESION Chemical bonding

5.THERMAL They have adequate thermal insulation

PROPERTY properties and help to protect from thermal hot
or cold sensations

6.AESTHETICS It is highly translucent with the considerable

amounts of unreacted glass core. So, it has good
aesthetics and can be used as anterior restorative
material.

7.POWDER/ 1.25–1.5 gm/ml

LIQUID RATIO

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CEMENTATION
 Clean and dry the tooth. Clean the tooth preparation with wet
flour of pumice on a rubber cup.

 Rinse the pumice away and then dry the tooth preparation.

 The manufacturer's prescribed powder-liquid ratio should be

rigidly observed.

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 Shake the powder bottle and then place two level scoops of
powder and four drops of liquid onto a glass slab. Mix the
cement as quickly as possible.

 Glass ionomer cement, liberates very little heat during mixing

and therefore can be mixed more rapidly over a smaller area.

 The mix must be completed within 60 seconds and should

have a creamy consistency.

 At first, a properly proportioned mixture will appear too thick,

but as the particles dissolve it will become less viscous.

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 Resist the temptation to add more liquid. Too thin a mix may
lead to microleakage and washout.

 Apply the cement to the restoration with a brush. It has been

theorized that placing a smaller amount of cement in the
crown will prevent a buildup of hydrostatic pressure from
excess cement. Seat the crown.

 Working time-3 minute

 The cement must be kept dry until it is hard. Keep the suction
device in place and replace cotton rolls as necessary.

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 When the excess cement extruded around the margins has
become doughy, cover it with petrolatum to prevent it from
dehydrating and cracking.

 Wait until the excess cement has become brittle, but before it
achieves its full hardness. The excess may then be removed
using a sealer, explorer, and floss.

 The material must be protected from moisture during its early

stages of set to prevent weakening.

 Cementation should be done before the cement loses its glossy

shiny appearance

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84
USES
Type I–luting cement: For cementation of metallic crowns,
bridges, porcelain restorations, orthodontic bands.

ADVANTAGES
Chemical adhesion to tooth structure, minimizes marginal
leakage
Anticariogenic property due to release of fluoride ions from
restoration
Excellent biocompatibility with pulp
Porcelain-like translucency
Favourable bioactive properties

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 COTE almost similar to tooth structure
 Good thermal insulator
 Freshly mixed cement has pseudoplastic property
 Manipulative procedure is simple.

DISADVANTAGES
 Low wear resistance
 Low fracture resistance and low tensile strength
 Moisture sensitivity, susceptibility to moisture uptake
 Initial slow setting

CONTRAINDICATIONS
 Should not be used in contact with the zinc oxide eugenol cements.

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RESIN MODIFIED GLASS
IONOMER CEMENT

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 Conventional and metal modified GIC are moisture sensitive and
have low early strengths.

 These drawbacks are due to slow acid base setting reaction. To

overcome these drawbacks, some polymerisable functional groups
(resins) have been added to impart additional curing process and
allow the bulk of matrix to set through acid base reaction in the
dual cure system.
Alternative names
 Resin ionomers (resinomer)
 Compomers (combination of composite resins and glass
ionomers)
 Hybrid ionomers
 Dual cure glass ionomers (material set by acid-base reaction and
light activated polymerization reaction).
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89
Tricure glass-ionomers
Acid-base, reaction has advantages: Fluoride release, chemical
adhesion and biocompatibility
Light curing polymerization reaction has advantages of
Improved physical properties, command setting, immediate
finishing and extended working time.
Chemically curing polymerization reaction has advantages of
bulk placement and controlled working and setting times.

90
 Conventional light curing glass ionomer offers improved
characteristics. However, to ensure whether light penetrates
throughout the entire material, the material has to be placed in
increments and cured.

 But in tricure system the additional chemical cure

polymerization makes bulk placement possible, assuring
optimum cure, even when light does not reach the entire bulk.
Hence, no incremental procedure is required, which also
saves time.

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COMPOSITION OF POWDER
Contains ion leachable glass with fluorides +
resin matrix (BISGMA) +
coupling agents (organosilanes) +
initiators (light initiators and chemical initiators or both).
Initiator for chemical curing is benzoyl peroxide. Initiators
for light curing is camphoroquinone with dimethyl paratoluidine
as accelerator.

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LIQUID
Aqueous solution of polyacrylic acid 30–50% with
some carboxyl groups, modified with methyl methacrylate and
HEMA (hydroxyethyl methacrylate)
chemical activator (N-N-dimethyl paratoluidine), light
accelerator dimethyl aminoethyl methacrylate or
camphoroquinone.

Itis also dispensed in disposable capsules and paste (syringe)

forms.

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PROPERTIES
Releases fluorides- Anticariogenic
Pulpal response- Mild (biocompatible with pulp)
Compressive strength- 105 MPa
Tensile strength- 20 MPa
Surface hardness- 40 KHN
Chemical adhesion to tooth structure
Exhibits greater degree of shrinkage on setting as a result of
polymerization

94
USES
Liner under composite resins
Core build up material
Fissure sealants
Cement base materials
Cementation materials for orthodontic bands.

CONTRAINDICATION
Resin-modified glass ionomers should be avoided with all-
ceramic restorations because they have been associated with
fracture; which is probably due to their water absorption and
expansion.

95
RESIN CEMENTS

96
 Resin cements are composites composed of a resin matrix, eg,
bis-GMA or diurethane methacrylate, and a filler of fine
inorganic particles.

 Resin cements are virtually insoluble and are much stronger

than conventional cements.

 It is their high tensile strength that makes them useful for

micromechanically bonding etched ceramic veneers and pitted
fixed partial denture retainers to etched enamel on tooth
preparations that would not be retentive enough to succeed
with conventional cements.

Stamatacos C, Simon JF. Cementation of indirect restorations: an overview of resin cements. Compendium of
continuing education in dentistry. 2013 Jan;34(1):42-. 97
98
According to ISO standard, that is, ISO 4049 Dentistry –
Polymer-based restorative materials resin-based luting agents
have to fulfil the following requirements:
Film thickness: < 50 μm
Working time at 23 °C: ≥ 60 s after mixing started, the
consistency should be homogenous
Curing time at 37 °C: < 10 min
Depth of cure: ≥ 1 mm for opaque shades ≥ 1.5 mm for other
shades
Flexural strength: > 50 MPa
Water sorption: ≤ 40 μg/mm3
Water solubility: ≤ 7.5 μg/mm3
Radiopacity: > 100 % Al

99
PROPERTIES
1.STRENGTH C.S-180-265MPa
T.S-34-37MPa
M.O.E.-2.1-3.1GPa
2.FILM
THICKNESS Less than or equal to 25µm

3.SOLUBILITY Insoluble to oral fluids

4.PULP Moderate
RESPONSE

5.ESTHETICS Excellent with availability of different shades

6.ADHESION Micromechanical bonding with enamel and

Dentin (possible chemical bonding)
100
ADVANTAGES OF RESIN CEMENT
 High strength
 Low oral solubility
 Excellent esthetics
 Good bonding with tooth enamel,dentin,alloys and ceramic surfaces.

DISADVANTAGES OF RESIN CEMENT

 Technique sensitive
 No fluoride release
 Polymerization shrinkage
 Pulpal sensitivity
 Difficulty in removing excess cement
 costly

101
CLASSIFICATION
Based on method of polymerization
1.Self cured or chemical cure
2.Light cured
3.Dual cured

Based on adhesive technique

1.Total etch resin cement
2.Self etch resin cement
3.Self adhesive resin cement

102
COMPOSITION
POWDER
1.Resin matrix
2.Silane treated inorganic fillers
3.Coupling agent
4.Photo or chemical initiators
5.Activators

Liquid
1.Adhesive monomer (HEMA and 4-META)
2.Organophosphate such as MDP
3.Tertiary amines

103
Self cure or chemical cure
Chemical-cure resin cements polymerize with a chemical
reaction and are referred to as “self-curing.” This means that two
materials must be mixed together to initiate this reaction.

Examples include: Panavia™ (Kuraray Dental) and C&B™

Cement (BISCO, Inc.).

Supplied as two component system

Two components mixed on paper pad

Mixing time 20-30 seconds

104
105
 Removal of excess cement becomes difficult if it is delayed
until the cement is polymerized.

 These cements are especially useful in areas where light-

curing is difficult. Some examples include metal restorations,
endodontic posts, and ceramic restorations that prohibit the
curing unit from adequately polymerizing the resin cement.

106
Light cured
Light-cure resin cements utilize photo-initiators, which are
activated by light.

The ability of light to penetrate all areas and activate the photo-
initiators is important with this type of cement.

Supplies as single component system.

Time of exposure of light for polymerization should never be less

than 40 seconds and it depends upon the intensity of light
transmitted and thickness of resin cement.

Excess of cement is removed after prosthesis is completely seated

107
108
 Light-polymerized resins are recommended when cementing
ceramic that is thin and fairly translucent, allowing the
transmission of light through it to reach the resin cement.

 Examples of light-polymerized cements include: RelyX™

Veneer Cement (3M ESPE); Variolink® Veneer (Ivoclar
Vivadent); and Choice™ 2 Light-Cured Veneer Cement
(BISCO).

ADVANTAGES
 An increased working time compared to the other cure types.

 Color stability compared to dual-cure or chemical-cure resin

cements. These cements are, therefore, suitable for esthetic
restorations and metal-free restorations. 109
Dual cure
 Dual-cure resin cements are capable of being cured by means
of both chemicals and light. Self-cure initiators that can cure
the cement are present. In addition, a curing light can be used
to activate the photo-initiators that are present in the cement.

 Basepaste consist of methacrylate monomers,fillers chemical

or light activated initiators.

 Catalyst paste consisits of methacrylate monomers, fillers and

activators.

 Mixing done similar to chemically cure system.

110
111
 Chemical activation is very slow and provides extended
working time until light activation starts.

 With light activation cement hardens rapidly.

 It continues to gain strength over an extended period of time

due to chemically activated polymerization process.

 Dual cure cement should not be used if the thickness of light

transmitting prosthesis is more than 2.5mm.

 Examples include: NX3 Nexus® Third Generation (Kerr);

RelyX™ ARC Adhesive Resin Cement (3M ESPE); and
Variolink® II (Ivoclar Vivadent Inc.).
112
113
Total etch
 Total-etch resin cements use a 30% to 40% phosphoric acid-
etch to etch dentin and enamel.

 This etching procedure removes the smear layer, and dentinal

tubules are opened.

  After etching, the adhesive is then applied to the preparation

to bond the cement to the tooth.

 These cements and the adhesives used with them can be light-
or dual-cured. 

114
115
 Total-etch resin cements have increased the bond strengths of
resin-based cements to nearly that of enamel bonding and have
significantly reduced microleakage.

  This category provides the highest cement-to-tooth bond but also

requires the most steps to bond ceramic, composite resin, or metal
to the tooth.

 This multi-step application technique is complex and

consequently might compromise bonding effectiveness, because
each step represents a possible contamination point

 Examples include: RelyX ARC (3M ESPE); Variolink II (Ivoclar

Vivadent Inc.); Choice 2 (BISCO, Inc.); and
Calibra® (DENTSPLY Caulk).
116
Self etch
In this system self etching primer is applied on the tooth surface
before applying resin cement.

Self etch resin cement can be of two step or one step system.

Two step consist of self etching primer and a hydrophobic

adhesive resin whereas one step system consist of etchant,primer
and bonding agent in a single bottle.

In this method the tooth surface is demineralized and infiltrated

at the same time.

117
118
 Although the smear layer is not removed but is impregnated
with acidic monomer.

 Bonding in this method also depends on micromechanical

interlocking.

 Self-etching systems are popular among dentists because they

are easy to use, eliminate steps during application with the
goal of reducing operator errors and technique sensitivity , but
as a general category they have demonstrated bond strength to
enamel that is weaker than that of total-etch systems.

119
Self adhesive
 A number of resin cements have been introduced as one-
component “universal adhesive cements”; they are said to have
good bond strengths to dentin, enamel, and porcelains without
the need for separate bonding agents.

  These self-adhesive cements can bond to an untreated tooth

surface that has not been micro-abraded or pretreated with an
etchant, primer, or bonding agent; thus, cementation is
accomplished in a single step.

 These cements contain phosphoric acid, which is grafted into

the resin.

120
121
 Once mixing is initiated, the phosphoric acid reacts with filler
particles and dentin in the presence of water, forming a bond.
The resin is polymerized into a cross-linked polymer, as is the
case with composite resin bonding.

 Examples include: RelyX™ Unicem (3M ESPE),

BisCem® (BISCO, Inc.), Maxcem Elite™ (Kerr Corporation),
SpeedCEM™ (Ivoclar Vivadent Inc.).

122
123
 CEMENTATION WITH RESIN
CEMENTS
There are many types of resin cement and each has specific
mixing instructions that should be reviewed before use.

124
NX3 Nexus (Kerr) for Cementation
Properly cleaned and etched porcelain restorations are silanated
with Kerr Silane, followed by air thinning and drying for 5-10
seconds.

Tissue is checked to ensure there is no bleeding that could

contaminate bonding. If bleeding occurs, it can be stopped with
Expasyl.

125
 Tooth preparations are etched with Kerr Phosphoric Acid for 15
seconds. The etch is rinsed away with water and the teeth are
dried but not desiccated.

 Once the teeth are properly etched, cleaned, and dried,

OptiBond Solo Plus is applied with a microbrush.

 To ensure evaporation of solvents and prevent pooling, use

with a scrubbing motion for 15 seconds, followed by air
thinning for 5 seconds.
126
 Once properly applied and air thinned to ensure no pooling of
the bonding agent, a Demi™ LED Curing Light is used to cure
for 5-10 seconds.

 The shade of dual- or light-cure NX3 cement selected during

try-in is applied to the etched/silanated porcelain restorations,
and properly seated with cleanup of the excess cement.

 A final cure with the Demi LED curing light is performed,

followed by final cleanup and polishing of the restorations.

127
128
Variolink N
Advantages
Easy and efficient application
Easy clean-up of excess cement
Very good physical properties, such as water absorption,
solubility and radiopacity

Indications
Metal and metal-ceramic
High-strength all-ceramic (zirconium and aluminium oxide-
ceramic, lithium-disilicate- ceramic)
Fibre-reinforced composite

129
130
131
132
133
Panavia cement
 The improved PANAVIA™ SA Cement Plus is a dual-cure,
fluoride-releasing, self-adhesive resin cement, offered in the
convenient Automix or the more economical Handmix
syringe. It provides improved bond strengths to natural teeth
and all popular materials, such as metal alloys, lithium
silicates, and zirconia.

  The restoration is cleaned, filled with cement 

134
135
136
137
SPECIAL CONSIDERATION

138
Cementation of gold inlays
 Because of their smaller size, inlays are more
difficult to handle and more readily aspirated by the patient
than are crowns.Therefore, trial insertion and cementation
should be carried out with a rubber dam in place.

 Before cementation, coat the tooth preparation with varnish or

dentin bonding agent.

 Then fill the cavity preparation with cement before inserting

the inlay.

139
 The inlay can be safely carried to the mouth by sticking it to a
gloved fingertip in the correct orientation with a small piece of
double-sided carpet tape or a spot of tray adhesive.

 After the cement has thoroughly hardened, remove the rubber

dam and check the occlusion.

 If adjustments must be made, repolish the occlusal surface

with several grades of progressively finer pumice, followed by
Amalgloss on a rubber cup or small brush

140
 Cementation of

141
Vargas MA, Bergeron C, Diaz-Arnold A. Cementing all-ceramic restorations: recommendations for success. The Journal of the American Dental
Association. 2011 Apr 1;142:20S-4S.
Cementation of veeners

142
143
144
145
146
147
148
149
150
151
152
Lumineers
What is the difference between Lumineers and standard porcelain
veneers?
The main difference is that Lumineers are made from a special
patented cerinate porcelain that is very strong but much thinner
than traditional laboratory-fabricated veneers.

 Their thickness is comparable to contact lenses.

Although Lumineers are the most advantageous option, but

there are certain limitations to be considered:

Lumineers can only be placed on teeth that are in good

structural condition. The teeth must be free of decay.
153
Cementation of lumineers
1.PREPARATION OF LUMINEERS® TO ENAMEL OR
DENTIN SURFACES
After the patient is seated, treat the LUMINEERS with
Porcelain Conditioner for 30 seconds. Rinse and dry well.

Apply Cerinate Prime® to the LUMINEERS for 30 seconds

and blow thin.

154
 Place LUMINEERS back into the case box in their proper
slots.

2. TRY-IN OF LUMINEERS
 a. Apply the mixture of Ultra-Bond Plus Try-In Paste and
Cerinate Shade Modifier/Opaquer into each of the
LUMINEERS.

155
 Gently place the LUMINEERS one at a time and use a brush
to clean up the excess Ultra-Bond Plus Try-In Paste

 Remove LUMINEERS and clean residual of Ultra-Bond

Plus Try-In Paste from the LUMINEERS with Tenure S.
3. PREPARATION OF TOOTH SURFACES
 Clean the teeth with a slurry of pumice and water or and floss

156
 Etch teeth for 20 seconds with Etch ‘N’ Seal. Rinse and dry

 Mix together equal amounts of Tenure A and Tenure B in a

dappen dish. Apply 5 coats of the Tenure A-B mixture to each
tooth (or until the surface is glossy) and 3 sweeps with a saliva
ejector. Let sit for 10-15 seconds, then gently air-dry

157
 One coat of Tenure S to be applied to the teeth.

4. BONDING LUMINEERS® TO AN ENAMEL OR

DENTIN SURFACE
 Apply Ultra-Bond Plus to the prepared LUMINEERS and
put in place

158
 Tack LUMINEERS in place for 2 seconds using the
Sapphire® PAC light fitted with a Ceri-Taper™ 2 mm
tacking tip. Do not touch our press on LUMINEERS® while
curing.

 Continue to remove excess cement with a soft brush coated

with Tenure S.
 Using a 9 mm tip and the Sapphire PAC light, completely
cure all LUMINEERS, exposing each surface for 5 seconds.
 Do not touch our press on LUMINEERS® while curing

159
 After cementation is completed finishing and polishing is
done.

160
MAINTAINENCE OF FIXED
PARTIAL DENTURE

161
 After placement and cementation of a fixed partial denture
(FPD), patient treatment continues with a carefully structured
sequence of postoperative appointments designed to monitor
the patient's dental health , stimulate meticulous plaque
control habits, identify any incipient disease, and introduce
whatever corrective treatment may be needed before
irreversible damage occurs.

162
POST CEMENTATION INSTRUCTION
The patient is asked to exercise all oral functions and awareness
should be created regarding the initial discomfort.
Sudden impact forces should be avoided in the restored area,
e.g.biting on a nut or metallic object.
Maintainence
•Oral hygiene procedures with special attention to use of
floss,inter dental brushes in the concerned area.
•Desensitizing tooth paste or mouth wash can be used if there is
sensitivity.
Regular recall visits for review
The patient is advised to report immediately if there is pain

163
DENTAL FLOSS
Dental floss (or simply floss) is a cord of thin filaments used to
remove food and dental plaque from between teeth in areas a
toothbrush is unable to reach.

The use of floss is commomnly recommended in order to

prevent gingivitis and the build up of plaque.

Routineuse of dental floss is low, ranging between 10% and

30% among adults

Ng E, Lim LP. An Overview of different interdental cleaning aids and their

effectiveness. Dentistry journal. 2019 Jun;7(2):56. 164
  TYPES OF GINGIVAL EMBRASURE
Three types of gingival embrasure are seen:
a)Type I: Embrasures are completely occupied by healthy interdental
papilla.
b)Type II:About 75% of embrasure is occupied by the gingiva.
c)Type III:About 50% of the embrasure is occupied by gingival

165
166
167
168
169
Flossing techniques
Wrap roughly 18 inches of floss around the two middle fingers;
the remaining floss can be secured around the preferred fingers of
the other hand.

Hold the floss firmly between your thumbs and forefingers - this
will help to free up the thumbs and index fingers, as it is these
fingers that will manipulate the floss.

Splitting the two tasks—holding and working the string—makes

flossing easier to accomplish.

The floss should be manoeuvred between the teeth with a gentle

rubbing motion and curved against one tooth until the floss meets
the gum line. 170
171
 Slide the floss gently between the gum and the tooth.

 The floss should be held firmly against the tooth and rub along
the surface of the tooth with a gentle up and down movement.
This should be continued until the back side of the last tooth is
reached. Follow this process for the remaining teeth.

 A new section of the floss should be used when plaque builds

up on it.

172
Interdental Brushes (IDBs)
They consist of a central metal wire core, with soft nylon
filaments twisted around.

The effectiveness of interdental brushes is well documented.

 One of the consensus findings from the European Federation of

Periodontology 2015 workshop states that “cleaning with
interdental brushes is the most effective method for interproximal
plaque removal, consistently associated with more plaque
removal than flossing or woodsticks”

173
174
 Different sizes allow for access to different sites within the
mouth, and the smallest interdental brushes would logically be
more effective and relevant for those with healthy gingiva and
smaller embrasures.

175
176
177
178
Oral Irrigators
Oral irrigators were first developed in 1962 as an alternative to
dental flossing. 

Also known as a “dental water jet”, “water pick”, or “dental

irrigator”, an oral irrigator uses a stream of pressurized, pulsating
water to clean between teeth and below the gum line.

 As a result, harmful deep periodontal pocket bacteria that could

not otherwise be reached through brushing or flossing, is flushed
out and removed.

179
 Oral irrigation is often recommended for people who are
unable to tolerate flossing.

 Sensitive gums, orthodontic appliances, diabetes, dental

implants, and non-compliance are all reasons why oral
irrigation is an effective alternative to flossing.

 For people with sensitive gums, flossing can prove to be

highly irritating.

180
Delivered By Power driven device
Generates an intermittent or pulsating jet of fluid.
An adjustable dial for regulation of pressure is provided along
with a held interchangeable tip that rotates 360 degree for
application at the gingival margin.

Non-power driven device

It’s attached to a household water supply and delivered through
a hand held interchangeable tip that can be used for application at
the gingival margin.

181
Dental water jet mechanism of action
Delivers pulsating fluid that incorporates a compression and
decompression phase.

This creates two zones of fluid movement called hydrokinetic

activity.

► Impact zone Initial fluid contact with an area of the mouth

► Flushing zone Depth of fluid penetration within a subgingival
sulcus or periodontal pocket

182
Fluid penetration depth
Toothbrush : 1-2mm
Rinsing : 2 mm
Floss : 3 mm
Dental water jet : 6mm
Toothpick/wooden wedge, interdental brush: Depends on the
size of the embrasure

183
Solutions can be used with the DWJ (Dental water Jet)
The most effective one is the one that is acceptable to the
patient.
 Water is highly effective and readily available
Chlorhexidine- In home should be diluted with water and its
better for subgingival penetration that rinsed. The dilution can
help minimize stainining.
 Irrigant solutions

1) Clorhexidine
2) Providone Iodine (1:9 water)- bacteriostatic activity
3) Water
4) Stannous fluoride (1:1)
5) Tetracycline
6) Listerine 184
Supragingival irrigation
The common home-use irrigator tip is a plastic nozzle with a 90-
degree bend at the tip attached to a pump providing pulsating beads of
water at speeds regulated by a dial.

 Patients should be instructed to aim the pulsating jet across the

proximal papilla, hold it there for 10 to 15 seconds, then trace along the
gingival margin to the next proximal space and repeat the procedure.

The irrigator should be used from both the buccal surface and lingual
surface.

Patients with gingival inflammation usually start at lower pressure

and then can increase the pressure comfortably to about medium as
tissue health improves.

185
In subgingival irrigation
Currently, two types of irrigator tips are useful for subgingival
irrigation.

The cannula type tip recommended for office use, and the other
is a soft rubber tip for patient use at home.

The subgingival irrigation tip should be gently inserted into

pockets or furcation areas, 3mm if possible, and each pocket
shoud be flushed for a few seconds.

Orthodontic irrigation, tip is placed 90 degree angle at neck of

tooth near gingival margin, direct tip towards brackets. Use light
contact.
186
Subgingival antimicrobial irrigants 
1. Chlorhexidine: PerioGard (11.6% alcohol), Peridex, and Oris
at 0.12%
2. Perio Med at 0.63% Stannous F
3. Listerine Antiseptic: Essential Oils (26.9% alcohol)
4. Sodium Hypchlorite
5. Povidone Iodine (Betadine, 10% for 5 minutes)

187
Proxa Brush Go
Betweens Proxa brush cleaners are designed in three individual
sizes that fit into tight, moderate or wide embrasure spaces.

With many root structures being concave interproximally, the

proper size brush is necessary to reach into the curvature of the
surface, and with a bulk holder

188
REVIEW OF LITERATURE

189
Cinar S, Altan B, Akgungor G. Comparison of Bond
Strength of Monolithic CAD-CAM Materials to
Resin Cement Using Different Surface Treatment
methods.
 Lithium disilicate glass ceramic (IPS e-max CAD), zirconia-
reinforced lithium silicate ceramic (Vita Suprinity), resin
nanoceramic (Lava Ultimate), and hybrid ceramic (Vita
Enamic) were used.

 Five groups of CAD-CAM blocks were treated as follows:

control (C), HF etching (HF), HF etching + silanization (HF +
S), sandblasting (SB), and sandblasting + silanization (SB +
S).

190
Journal of Advanced Oral Research. 2019 Nov;10(2):120-7
 After surface treatments, SEM analyses were conducted.
Specimens were cemented with self-adhesive resin cement
(Theracem) and stored in distilled water at 37°C for 24 h.
Shear bond strength (SBS) was measured, and failure types
were categorized.

 Among the CAD-CAM materials, the highest SBS was

reported in the HF + S group for Vita Enamic. Although IPS
e.max CAD, Vita Suprinity, and Vita Enamic showed higher
bond strength when treated with HF + S, Lava Ultimate has
the highest bond strength value when treated with SB + S.

191
Johnson GH,Lepe X,Patterson A,Schafer O.
Simplified cementation of lithium disilicate crowns:
retention with various adhesive resin cement
combinations.
The purpose of this in vitro study was to determine
whether lithium disilicate crowns cemented with a new
composite resin and adhesive system and 2 other popular
systems provide clinically acceptable crown retention after
long-term aging with monthly thermocycling.

192
The Journal of prosthetic dentistry. 2018 May 1;119(5):826-32.
 Extracted human molars were prepared with a flat
occlusal surface, 20-degree convergence, and 4 mm
axial length. The axio-occlusal line angle was slightly
rounded.

 The preparation surface area was determined by optical

scanning and the analysis of the standard tessellation
language (STL) files. The specimens were distributed
into 3 cement groups (n=12) to obtain equal mean
surface areas.

 recorded

193
 Lithium disilicate crowns (IPS e.max Press) were fabricated for
each preparation, etched with 9.5% hydrofluoric acid for 15
seconds, and cleaned.

 Cement systems were RelyX Ultimate with Scotch Bond

Universal (3M Dental Products); Monobond S, Multilink
Automix with Multilink Primer A and B (Ivoclar Vivadent
AG); and NX3 Nexus with OptiBond XTR (Kerr Corp).

 Each adhesive provided self-etching of the dentin. Before

cementation, the prepared specimens were stored in 35C water.

 A force of 196 N was used to cement the crowns, and the

specimens were polymerized in a 35C oven at 100% humidity.
194
 After 24 hours of storage at 100% humidity, the cemented
crowns were thermocycled (5C to 55C) for 5000 cycles each
month for 6 months. The crowns were removed axially at 0.5
mm/min. The removal force was recorded and the
dislodgement stress calculated using the preparation surface
area. The type of cement failure was recorded.

 IPS e.max Press (lithium disilicate) crowns were well retained

(2.9-3.9 MPa; 387-522 N) by the 3 cement-adhesive
combinations after 6 months of aging with monthly
thermocycling

195
CONCLUSION

196
 Proper moisture control is essential for the cementation step.
The restoration must be carefully prepared for cementation,
including the removal of all polishing compounds.

 Airborne particle abrading the fitting surface is recommended.

 The luting agent of choice is mixed according to the

manufacturer’s recommendations

 The luting agent must be protected from moisture during its

initial set.

 Removal of excess luting agent from the gingival sulcus is

crucial for continued periodontal health.
197
REFERENCES

198
 Anusavice;Phillip’s Science Of Dental Materials;12th Edition
Elsevier; 2013
 Herbert T. Shillingburg;Shillingburg Fundamentals of fixed
prosthodontics;4th edition;2000
 STEPHEN F. ROSENSTIEL;Rosensteil contemporary fixed
prosthodontics;3th edition;2001.
 G. Eliades,D. C.Watts,T. Eliades; Dental Hard Tissues and
Bonding;1st edition;2005
 S.Mahalaxmi. Materials Used In Dentistry. 5th Edition.
Wolters Kluwer;2016
 Robert G Craig,John M Powas;Restorative Dental
Materials;11th Edition;Mosby;2002
 V Shama Bhat, Nandish BT.Science Of Dental Materials.2nd
Edition.Delhi:CBS Publishers; 2013
199
 Ng E, Lim LP. An Overview of different interdental cleaning
aids and their effectiveness. Dentistry journal. 2019 Jun;7(2):56.
 Vargas MA, Bergeron C, Diaz-Arnold A. Cementing all-
ceramic restorations: recommendations for success. The Journal
of the American Dental Association. 2011 Apr 1;142:20S-4S.
 Stamatacos C, Simon JF. Cementation of indirect restorations:
an overview of resin cements. Compendium of continuing
education in dentistry. 2013 Jan;34(1):42-.
 Cinar S, Altan B, Akgungor G. Comparison of Bond Strength of
Monolithic CAD-CAM Materials to Resin Cement Using
Different Surface Treatment Methods. Journal of Advanced
Oral Research. 2019 Nov;10(2):120-7.

200
 Johnson GH, Lepe X, Patterson A, Schäfer O. Simplified
cementation of lithium disilicate crowns: retention with
various adhesive resin cement combinations. The Journal of
prosthetic dentistry. 2018 May 1;119(5):826-32.
 Abdullah S, Pavithra S, Ahmed N. Interdental Aids-A
Literature Review. Open Access J Dent Sci.
2018;3(5):000182.

201
THANK YOU

202
 Set cement is a cored structure consisting
unreacted zinc oxide particles embedded
in amorphous matrix of zinc
alminophosphate.

203
RESIN
 The basic composition of the most modern resin based cements is similar to
that of resin based composite filling material.
 Monomers with functional groups that have been used to induce bonding to
dentin are often incorporated in these cements.
 They have organophosphates, hydroxyethyl methacrylate (HEMA), and the
4 methacyrlethyl-trimellitic anhydride (4-META) system.
 Bonding of the cement to enamel can be attained through the acid etch
technique.
 Polymerization can be achieved by the conventional peroxide amine
induction system or by light activation.
 Some cements are autopolymerising for use under light blocking metallic
restorations, while others are either entirely photo cured or dual cured (light
activated)
 The fillers are those used in composites (silica or glass particles, 10 to 15μ
m in diameter) and the colloidal silica is that used in micro filled resins.

204
 Harden cement consist of a amorphous
gel matrix in which unreacted particle are
dispersed.

205
 GIC POWDER AND LIQUID ARE MIX

SURFACE OF THE GLASS PARTICAL ATTACK BY ACID

Leach in to aqueous medium

Not

fluorine
par

Na Ca
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Al
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ate

m
olid
S ix
with

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ent
Cross link m
ce
in

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ly a
cro

h
cry wit
lic nd
ss l

aci u
dc n bo
ink

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n A me
orm ce
of c

f d
ase rigi
e

ph dt
o
me

new lea
nt

24h Th
is
n
t hi
Wi 206
 Some sodium ion may replace the
hydrogen ion of carboxylic group. Where
as rest combine with fluorine ions forming
Na fluoride which is uniformly disperse
with in the cement.

207
 ZOE

208
 Mixing
 Zinc phosphate
 Mixing is initiated by the addition of a small
amount of powder. Small quantities are
incorporated initially with brisk spatulation.
 A considerable area of the mixing slab should
be used.
 A good rule to follow is to sptulation increment
for 15 seconds before adding another increment.
 Complete of mixing usually requires
approximately 1 minute and 3Oseconds.
209
Zinc polycarboxylate
 The cement liquids are quite viscous.
 Viscosity is a function of the molecular weight and the concentration
of the polyacrylic acid thereby varies from one product to another.
 Generally the powder liquid ratio is 1.5 parts of powder to 1 part of
liquid by weight.
 The consistency of the mixes is creamy compared with that of zinc
phosphate cements.
 The cement liquid should be mixed on a surface that does not
absorb liquid.
 A glass slab affords the advantage over paper pads supplied by the
manufacturers because once it is cooled it maintains the
temperature longer.
 The cool slab and powder provides for longer working time, but
under no circumstances should the liquid be cooled in a refrigerator.

210
 Mix polyacrylate cements within 30 to 60
seconds, with half to all of the powder
incorporated at once to provide the
maximum length of working time 2.5 to 6
minutes.
 Working time can be extended to 10-15
minutes by using a cool slab chilled to 4˚C.
 The liquid should not be dispensed before
the time when the mix is to be made. It
loses water to the atmosphere rapidly and
this results in marked increase in viscosity.
211
 Use the mixed cement only as long as it
appears glossy on the surface.

 Once the surface becomes dull, the

cement develops stringiness and the film
thickness becomes too great to seat a
casting completely.

212
Glass ionomer cement
 Glass ionomer cements mixed with carboxylic acid
liquids have a powder liquid ratio of 1.3: 1 or 1.35: 1, but
it is the range of 1.25 to 1.5 g of powder per 1 ml of
liquid.
 The powder and liquid are dispensed on a paper or a
glass slab.
 A cool dry glass slab may be used to slow down the
reaction and extend the working time the slab should not
be used if the temperature is below dew point, that is, at
temperatures that enhance moisture condensation on
the glass slab that can alter the acid water balance
needed for a proper reaction.
 By waiting for a few minutes, the temperature of the slab
will rise sufficiently until water vapor no longer
condenses on its surface.
213
 The powder is divided into two equal portions.

 The first portion is incorporated into the liquid with a stiff

spatula before the second portion is added.

 The mixing time is 30 to 60 seconds.

 At this time the mix should have a glossy surface.

 The shiny surface indicates the presence of polyacid that

has not participated in the setting reaction. The residual
acid ensures adhesive bonding to the tooth.

 If the mixing process is prolonged, a dull surface

develops, and adhesion will not be achieved.
214
 Encapsulated products are typically mixed for 10
seconds in a mechanical mixer and dispensed directly
onto the tooth and restoration.
 The cement must be used immediately because the
working time after mixing is about 2 minutes at room
temperature.
 An extension of the working time to 9 minutes can be
achieved by mixing on a cool slab, (3˚ C), but because a
reduction in compressive strength and modulus of
elasticity is observed, this technique is not
recommended.
 Do not use the cement once a skin forms on the surface
or when the viscosity increases.
 Glass ionomer cements are very sensitive to contact with
water during setting. The filed must be isolated
completely. Once the cement has achieved its initial set
(7 minutes), coat the cement margins with the coating
215
agents supplied with the cement.
ZOE
 Setting reaction is not significantly exothermic, a
cooled mixing slab is not required.
 Usually a paper mixing pad with disposable
sheets is used, which facilitates the cleanup
procedures after cementation.
 Bulk of the powder is incorporated in the initial
step, the mix is thoroughly spatulated, and a
series of smaller amounts is then added until the
mix is complete.
 The mix is thoroughly knaded with the spatula (a
stiff bladed steel spatula is the most effective
type).
216
RSIN CEMENT
 CHEMICALLY ACTIVATED
 The chemically activated versions of theses
cements are supplied as two component
systems a powder and a liquid or two pastes.
 The two components are combined by mixing on
the paper pad for 20 to 30 seconds.
 Remove the excess cement immediately after
the restoration is seated.

217
LIGHT CURE
 Light cured cements are single component systems just
as are the light cured filling resins.

 They are widely used for cementation of porcelain and

glass ceramic restorations.

 The time of exposure to the light that is needed for

polymerization of the resin cement is dependant on the
light transmitted through the ceramic restoration and the
layer of polymeric cement.

 Time of exposure to the light should never be less than

40 seconds.
218
DUAL CURE
 The dual cure cements are two component
systems and require mixing that similar to the
chemically activated systems.

 The chemical activation is slow and provides

extended working time until the cement is
exposed to the curing light, at which point the
cement solidifies rapidly.

 It is continues to gain strength over an extended

period because of the chemically activated
polymerization.

219
MECHANISM OF RETENTION
A prosthesis can be retained by mechanical or chemical
means or a combination of mechanical and chemical
factors.
 Surfaces are rough, and the cement fills the roughness of
both surfaces.

 The entire interface region then appears continuous, and

the cement layer can resist shear stress acting along the
interface.
 This situation represents a typical mechanical retention,
and the strength of retention depends on the strength of
the cement, which resists applied forces that may act to
dislodge a prosthesis.
220
 For certain situations, mechanical retention alone is
insufficient, and incomplete wetting can also leave voids
on the surface that may allow an influx of oral fluids.

 Because of these deficiencies, chemical bonding as a

means of retention is the ultimate goal.

 Aqueous cements based on polyacrylic acids do provide

chemical bonding through the use of acrylic acids.

 Resin based cements using some specialty functional

groups also have exhibited chemical bonding.

221
Adhesion of resin to enemel
 Acid-etching transforms the smooth enamel into
very irregular surface and also increases surface
free energy. When a fluid resin-based material
applied to the irregular etched surface, the resin
penetrates into the surface, aided by capillary
action.

 Monomers in the material polymerize, and the

material interlocked with the enamel surface. The
formation of resin microtags within the enamel
surface is the fundamental mechanism of
adhesion of resin to enamel.

222
Adhesion of resin to dentine
 Ahesive material can interact with dentine
in different way mechanically and
chemically or both way.
 Research believed that dentine adhesion
relies primarily on the penetration of
adhesive monomer into the filigree of
collagen fibres which left exposed by acid
etching.

223
Adhesive of GIC
 The mechanism by which the glass ionomer
bonds to tooth structure has not been clearly
elucidated.
 It primarily involves chelation of carboxyl groups
of the polyacids with the calcium in the apatite of
the enamel and dentin.
 The bond to enamel is always higher than that to
dentin, probably because of the greater
inorganic content of enamel and its greater
homogeneity from a morphologic standpoint.

224
Adhesion of polycarboxylate
 The mechanism is not entirely understood
but is probably analogous to that of the
setting reaction.
 polyacrylic acid is believed to react via the
carboxyl goups with calcium of
hydroxyapatite.

225
PROPERTIES
 Biologic properties
 Biocompatible
 An ideal dental luting agent should be biocompatible,
that is, have little interaction with body tissues and fluids,
be nontoxic, and have low allergic potential.
 Polycarboxylate or reinforced zinc oxide/eugenol
cements have been recommended over the stronger
zinc phosphate and glass ionomer if pulpal irritation is a
concern.
 These cements are more biocompatible because the
setting cement has a higher pH and restorations
cemented with these cements exhibit lower bacterial.
 At the histologic level, luting agents appear to cause little
pulpal response, particularly if the remaining dentin
thickness exceeds 1 mm.
226
227
 Caries or plaque inhibition.
 Caries is one of the primary causes of failure of
cast restorations, so an ideal luting agent would
actively prevent caries at the restoration-tooth
interface.
 Popularity of the glass ionomer luting cements is
undoubtedly due to the fluoride release
associated with these materials and the
presumed benefit of reduced caries.
 The goal of caries prevention also justifies the
incorporation of fluoride into other luting agents
such as polycarboxylates.
228
 In vivo, glass ionomer cement has been
shown to increase the fluoride ion
concentration in the saliva in the short-
term.

229
ANTIMICROBIAL PROPERTIES

230
MICROLEAKAGE.
 Microleakage of organisms around dental
restorations has been implicated in adverse
pulpal response and hence reduced restoration
longevity.
 Restoration cemented with an ideal dental agent
would be resistant to microleakage. Researchers
have attempted to simulate leakage of bacteria
and/or their toxins with the use of stains and
exposure to radioactive Ca solution

231
 Nonadhesive resins have increased microleakage
compared with traditional cements, whereas adhesive
resin systems have reduced microleakage in vitro and also
in vivo testing

232
Mechanical properties
 ISO NO 9917 & ADA SPEC NO 96

233
234
 CEMENT COM strength tensile strength MOE
MPa MPa GPa
 Zinc phosphate 96-130 3-5 9-13
 Zinc polycarboxilate 55-96 3-6 4.4
 GIC 90-220 4.5 5.4
 Adhesive resin 50-210 40 1.2-10.7
 TEMPARARY CEMENT
 Noneugenole Zinc oxide 2-5 .4-1.0 0.18
 Zinc oxide eugenole 2-14 _ _

235
 EFFECT OF TEMPERATURE
 Some luting agents are markedly affected by changes in
temperature.
 Mesu etal found that the strength of EBA-reinforced zinc
oxide/eugenol cement was particularly affected, whereas zinc
phosphate was little changed. He did not test a glassionomer
cement,

236
WATER SORPTION
 Resin cements, particularly the urethane- based
materials, are susceptible to water sorption, with
less heavily filled materials exhibiting greater
sorption of the popular adhesive resin luting
agents, unfilled materials such as C&B
Metabond and the resin-modified glass ionomers
exhibit the greatest water sorption.
 Water sorption will adversely affect the
mechanical properties of the resin, although the
resultant expansion may be beneficial as it
counteracts polymerization shrinkage

237
Radiopacity.
 An ideal luting agent should be radiopaque to enable the
practitioner to distinguish between a cement line and
recurrent caries, as well as detect cement overhangs.
 Combinations of composite luting cements and/or glass
ionomer cements may show gap-like features because
of differences in radiopacity.
 Therefore it is important that luting agents have greater
radiopacity than dentin. Problems of interpretations
about the presence of secondary caries or gaps near the
restoration may then be avoided.

238
 WORKING TIME AND SETTING
TIME
 Working time is the time measured from the
start of the mixing during which the viscosity
(consistency) of the mix is low enough to flow
readily under pressure to form a thin film.
 Setting time is the time elapsed from the start
of the mixing until the point of the needle no
longer penetrates the cement as the needle is
lowered onto the surface.

239
 CEMENT WORK TIME SETTING TIME
minute minute
Zinc phosphate 5 2.5-8

Zinc polycarboxilate 2.5 6-9

GIC 3-5 6-8

ZOE _ 4-10

RESIN _ _
240
Powder/liquid ratio
 Zinc phosphate 1.4 gm powder : .5 ml of liquid
 Zinc polycarboxilate 1.5gm of powder : 1.0 gm of liquid
 GIC 1.25 to 1.5 g of powder per 1 ml of liquid
 ZOE 1.25- 1.50g of powder with 1ml of
liquid
 RESIN

241
242
Preparation of the Restoration and
Tooth Surface for Cementation
 The performance of all luting agents is
degraded if the material is contaminated
with water, blood, or saliva.
 Restoration and tooth must be carefully
cleaned and dried after the evaluation
procedure.
 Excessive drying of the tooth must be
avoided to prevent damage to the
odontoblasts.
243
 The casting is best prepared by airborne particle
abrading the fitting surface with 50-ųm alumina.
 This should be done carefully to avoid abrading
the polished surfaces or margins.
 Air abrasion has increased in vitro retention of
castings by 64%.
 Alternative cleaning methods include steam
cleaning, ultrasonics, and organic solvents

244
 Before the initiation of cement mixing, isolating
the area of cementation, cleaning and drying the
tooth is mandatory. However, the tooth should
never be excessively desiccated.
 Overdrying the prepared tooth leads to
postoperative sensitivity.
 If a non- adhesive cement (zinc phosphate) is to
be used, the tooth should be cleaned, gently
dried, and coated with cavity varnish or dentin-
bonding resin.
 varnish should not be applied when an adhesive
material, such as resin, glass ionomer, or
polycarboxylate, is used, because it would
prevent the material’s adhesion to dentin
245
Armamentarium for placement of
cement
 Mirror
 Explorer
 Dental floss
 Cotton rolls
 Prophylaxis cup
 Flour of pumice
 Cement (powder and liquid)
 White stones
 Cuttle disks
 Local anesthetic (if needed)
 Saliva evacuator
 Forceps
 Thick glass slab (chilled)
 Cement spatula
 Gauze squares
 Adhesive foil
 Plastic instrument Step by step procedure
246
PLACEMENT OF CEMENT
 Place the cement on the internal surface
of the prosthesis and extended slightly
over the margin,
 Seating it over the preparation and remove
the excess cement at an appropriate time.

247
 Cement paste should coat the entire inner
surface of the crown and extent slightly beyond
the margin.
 It should fill about half of the interior crown
volume.
 Clinician should make certain that occlusion
aspect of the tooth preparation is free of voids to
ensure that there is no air entrapment during the
stage of seating

248
SEATING
 Moderate fingure pressure should be used
to displace excess cement and to seat the
crown.

 Alternative method is used a vibrational

instrument to facilitate the seating the
prosthosis with out creating excess
pressure.
249
 After the marginal gap area is evaluated
for closer with the explorer, the patient
may be asked to complete the seating by
biting on a soft piece of wood.

 During this stage last increment of excess

cement is expelled through the space
between the prosthesis and the tooth

250
 As the prosthesis reach the final position
on the preparation, the space of expelling
the excess cement become smaller,
making the seating is more difficult.

 Variables that can facilitate seating include

using a cement of lower viscosity,
increasing the taper and decrease the
height of the crown preparation.
251
REMOVAL OF EXCESS CEMENT
 Excess cement accumulate around the marginal
area at the completion of seating.
 Cement removals depends on the property of
cement used.
 If the cement is sets to a brittle state and does
not adhere to the surrounding surface, the tooth,
and the prosthesis, it is best removed after it
sets. This appliance to zinc phosphate, silico
phosphate, and ZOE cements
252
 Glass ionomer cements, polycarboxylate cements and
resin based cement that are potentially capable to
adhering both chemically and physically to the
surrounding surfaces,
 the protocol of excess cement removal varies, one can
coat the surrounding surface with the separating medium
such as petroleum jelly, there by inhibiting the material
adherence to the surfaces, and remove the excess after
the cement sets.
 Another technique to involves the removal of excess
cement as soon as the seating is completed, thus
preventing the material from adhering to the adjusting
surface

253
POST-CEMENTATION
 Aqueous – based cements continue to mature over time
well after they have passed the defined setting time.
 If they are allowed to mature in an isolated environment,
that is, free of contamination from surrounding moisture
and free from loss of water through evaporation, the
cements will acquire additional strength and become more
resistant to dissolution.
 It is recommended that coats of varnish or a bonding
agent should be placed around the margin before the
patient is discharged.

254
 An appointment is generally scheduled within a week or
10 days after cementation.
 The prosthodontist should check carefully that the
gingival sulcus remains clear of any residual cement.

 The presence of “polished” facets on the contacting

surfaces of the cast restorations at post cementation
appointments should lead to a careful reassessment and
correction of the occlusion.

 If any minor shift in tooth position has occurred, occlusal

adjustment may be necessary

255
ESTHETIC
 The esthetic properties of luting agents are of
considerable significance with the increasing
use of translucent ceramic restorations,
especially for anterior restorations.
 Expanded kits of resin cements with
accessories, tints, opaque, and multiple shades
are tailored to anterior ceramic restorations and
shade corrections to be made.
 Water-soluble try-in pastes are recommended
and should be accurately color matched to the
cement shade.
 In practice, the color of the try-in paste may
differ significantly from the cement.
256
Color stability
 When considering enhancing esthetics by controlling the
color of cements, the effect of cement color change over
time should be considered.
 The amine accelerator necessary for dual polymerization
can cause the color of the luting agent to change over
time.
 Therefore many practitioners prefer light-cured resin
cements for luting of porcelain veneers and other
esthetic restorations because it is thought that they are
more color stable.
 Noie et al have shown that measurable color changes of
dual resin cements were detected under accelerated
aging, they were not found to be visually perceptible.
 Their findings suggest that the practitioner can use dual-
cure resin cements in esthetic areas with confidence.
257
 Another study involving color stability of 5 dual-cure resin
cements
 (KerrPorcelite, Jelenko PVS System, Vivadent Heliolink,
Mirage FLC, Denmat Ultrabond)
 concluded that Heliolink showed the least and Porcelite
the greatest color change.
 It was found that all dual-cure composite cements tested
exhibited some short- and long-term color changes.

258
CEMENTATION PROCEDURES
FOR CERAMIC VENEERS AND
INLAY
 Composite resin luting agents are available in a
range of formulations.
 For veneers, a light-cured Bonding the
Restoration material can be used.
 For inlays, chemical cure material is preferred.
 In clinical testing, restorations chemically cured
materials have performed than dual-cured luted
restorations.
 Shade of veneers can be modified shade of the
luting agent. To facilitate color-matched try-in
pastes are some manufacturers
259
ARMAMTARIUM
 Mirror
 Explorer
 Rubber dam kit
 Local anesthetic
 Saliva evacuator
 Forceps
 Scalpel
 Curette
 Plastic instrument
 Dental tape
 Mylar strips
 Cotton rolls
 Prophylaxis cup
260
 Flour of pumice
 Acid etchant
 Porcelain etchant
 Silane coupling agent
 Acetone
 Glycerin or try-in paste
 Bonding agent
 Brush
 Resin luting agent
 Curing light
 Fine grit diamonds
 Porcelain polishing kit
261
STEP BY STEP PROCEDURE
 Clean the teeth with pumice and water.
 Isolate them the rubber dam or displacement
cord.
 A luting agent that contains ZOE should be
avoided cementing interim restorations before
resin bonding, because eugenol inhibits the
polimerization of the resin.
 Cleansing with pumice leaves a ZOE residue
mixed with pumice, which can inhibit bonding.
 Etching with 37% phosphoric acid after cleaning
with pumice may be the best way to remove
ZOE
262
 2 Evaluate the restorations with glycerin or
a try in paste. Verify fit, shade, insertion
sequence.

 3 Clean the restorations thoroughly in

water with ultrasonic agitation. Use
acetone if luting resin was used to verify
the shade at evaluation.
 Dry the restorations 263
 5 Acid etch the enamel; 37% phosphoric
generally used and is applied for 20 second
rinse thoroughly and dry.
 6 Apply a thin layer of bonding resin to the
preparation. Brush, rather than air thin, the
boning resin, because air thinning might inhibit
polymerization.
 Do not polymerize this layer because it might
interfere with complete setting

264
 7 For veneers, place a Mylar matrix strip
at the mesial and distal surfaces of the
prepared tooth.

 8 Apply composite resin luting agent to the

restoration; be especially careful to avoid
traping air.

 Dual cure is recommended for and onlays;

 light cure is recommended veneers.

265
 9 Position the restoration gently, removing
luting agent with an instrument.

 10 Hold the restoration in place while light

curing the resin. Do not press on the
center of veneers they may flex and break.

266
 11 Use dental tape to remove resin flash from
interproximal margins of inlays and before curing these
areas.
 12. Do not undercure the resin cement. Allow at least 40
seconds for each area.
 13. Remove resin flash with a scalpel or sharp curette.

 14. Finish accessible margins and occlusion with fine

diamonds, using water spray. Use finishing strips for the
interproximal margins.
 15. Polish adjusted areas with rubber wheels or points
and then with diamond polishing paste.
267
CONCLUSION
 Luting agent cannot completely
compensate for the shortcomings of the
preparation retention and resistance forms
or ill fitting, low strength restorations.

 Prosthdontics must be aware of the virtues

and shortcomings of each cement type
and select them appropriately.

268
BIBLIOGRAPHY
 The glossary of prosthodontic terms july 2005, vol 94.
 Stephen F. Rosenstiel, Martin F. Land, and Bruce J.
Crispin; Dental luting agents: A review of the current
literature; J Prosthet Dent 1998;80:280-301.
 Anusavice, science of dental materials, 1996, 10the edition page no,
525-580.
 Craig Robert.G, Restorative dental materials, 1996, 594-626th .
 Brien,o Craig, dental materials property and manipulation, 1995, 6th
edition, page no 114-132
 Strudavent; art and science of operative dentistry mosby
publication; fourth edition ;2002 p.g no 309-334.

269