Advanced Cementation Update
Webinar
Advanced Cementation Update
Webinar
WebinarOctober 14th
WebinarOctober 14th
John Nosti, DMDJohn Nosti, DMDwww.clinicalmastery.com
The Why, Where, & When of bite relationships
The Why, Where, & When of bite relationships
CementationCementationAdhesion
“total-etch”, resin cementSemi-adhesion
Self-etching resin cementNon-adhesion
Glass Ionomer, resinionomer, zinc phosphate, polycarboxylate
Adhesion“total-etch”, resin cement
Semi-adhesionSelf-etching resin cement
Non-adhesionGlass Ionomer,
resinionomer, zinc phosphate, polycarboxylate
Cement Requirements
Cement RequirementsLack of post-operative sensitivity
Strong bond and good seal -to the tooth and to the restorative material
Easy placement and clean-upEsthetics compatible with the restorative material
Minimal film thicknessRadiopaque (posterior)
Lack of post-operative sensitivityStrong bond and good seal -to the tooth and to the restorative material
Easy placement and clean-upEsthetics compatible with the restorative material
Minimal film thicknessRadiopaque (posterior)
Powder liquid ceramic or
Pressed ceramic restorations
Powder liquid ceramic or
Pressed ceramic restorations
“Total-etch”with
Resin Cement
“Total-etch”with
Resin Cement
“Tack & Wave”
Cementation
“Tack & Wave”
CementationVeneers and anterior crownsVeneers and anterior crowns
Emprethin evaluationEmprethin evaluation
Be Careful!!!Be Careful!!!0.2 mm glass is fragile!0.2 mm glass is fragile!
OptraGate (Ivoclar)OptraGate (Ivoclar)
Hydrogen Peroxide in Ultradent SyringeHydrogen Peroxide in Ultradent Syringe
Metal strip removes any interproximal Luxatemp and
freshens the enamel
Metal strip removes any interproximal Luxatemp and
freshens the enamel
Try in independently
DRY
Try in independently
DRY
Occlude Spray Powder (Pascal)Occlude Spray Powder (Pascal)
Try-in collectively DRY!Try-in collectively DRY!
Check complete seatingProximal contacts
Check complete seatingProximal contacts
Dry Erase Marker Dry Erase Marker
Mesial SurfaceMesial Surface
Distal
Surface
Distal
Surface
Variolink Veneer(Ivoclar/Vivadent)
Variolink Veneer(Ivoclar/Vivadent)
Value based0+1, +2, +3-1, -2, -3Microfill
Value based0+1, +2, +3-1, -2, -3Microfill
00 +2+2
Clean and acidify with 35% Phosphoric acidClean and acidify with 35% Phosphoric acid
Silane Coupling Agent (Relyx Ceramic primer) placed for 1 minuteSilane Coupling Agent (Relyx Ceramic primer) placed for 1 minute
Place bonding agent (All Bond 3) inside dry restorationPlace bonding agent (All Bond 3) inside dry restoration
Load restoration with resin cementLoad restoration with resin cement
Vivapad (Ivoclar)Vivapad (Ivoclar)
Etch with 35% phosphoric acid for 15 seconds per toothEtch with 35% phosphoric acid for 15 seconds per tooth
Apply Systemp desensitizer for 15 secondsApply Systemp desensitizer for 15 seconds
Effect of Remoistening
Water-blotted dry 22.8
Water- wet 19.2
Gluma Desensitizer 22.3
HurriSeal 20.1
Vivadent Desensitizer 25.8
MicroPrime 20.1
Aqua-Prep 18.1
Product Dentinal Bond
Water vs. Desensitizer/Rewetting
Agent
“suction” away excess; do not desiccate“suction” away excess; do not desiccate
Apply 2 coats of All Bond 3 A & B Primer mixApply 2 coats of All Bond 3 A & B Primer mix
Adec Warm Air Tooth DryerAdec Warm Air Tooth Dryer
Seat all restorations at one time; do not remove excess resin cement
Seat all restorations at one time; do not remove excess resin cement
Polymerize “dead center” each restoration for 1 second using a
2.0 mm light guide (Ivoclar)
Polymerize “dead center” each restoration for 1 second using a
2.0 mm light guide (Ivoclar)
Hold light guide 1 inch from restorations and light cure 3-5 seconds on facial and lingual
Hold light guide 1 inch from restorations and light cure 3-5 seconds on facial and lingual
General GuidelinesGeneral
Guidelines+2: 5 seconds0: 3 seconds-3: 5 seconds +
+2: 5 seconds0: 3 seconds-3: 5 seconds +
“Pick" away excess using Bard Parker or scaler“Pick" away excess using Bard Parker or scaler
Floss through contacts using a Brasseler Serrated SawFloss through contacts using a Brasseler Serrated Saw
Floss through contacts using waxed dental flossFloss through contacts using waxed dental floss
Place DeOx (Ultradent) on all marginsPlace DeOx (Ultradent) on all margins
Light polymerize for at least 60 seconds per tooth from both buccal and lingual
Light polymerize for at least 60 seconds per tooth from both buccal and lingual
Curing LightsCuring Lights
PhotoinitiatorsCamphoroquinone- 470-490 nm
PhenylDipropandione- 430 nm
PhotoinitiatorsCamphoroquinone- 470-490 nm
PhenylDipropandione- 430 nm
0
10
20
30
40
300 350 400 450 500 600
CQ
CQ 488 nm PDP 430 nm
Wavelength (nm)
OptiLux 501(Demetron)OptiLux 501(Demetron)
Emits light with wavelength 390-510 nm
0
10
20
30
40
300 350 400 450 500 600
CQ
CQ 488 nm PDP 430 nm
Wavelength (nm)
LED Lighti.e.. Freelight (3M), LEDemetron (Kerr),,BluPhase (Ivoclar), DEMI (Kerr)…
LED Lighti.e.. Freelight (3M), LEDemetron (Kerr),,BluPhase (Ivoclar), DEMI (Kerr)…
-No bulb degradation
-Portable
-Wavelength output 450-500 nm
-No bulb degradation
-Portable
-Wavelength output 450-500 nm
0
10
20
30
40
300 350 400 450 500 600
CQ
CQ 468 nm PDP 430 nm
Wavelength (nm)
BluePhase G2(Ivoclar)
BluePhase G2(Ivoclar)
Emits light with wavelength 390-510 nm
Fusionwww.dentlight.com
Remove excess resin cement with Scaler, #12 & #15 Bard-parker Blades
Remove excess resin cement with Scaler, #12 & #15 Bard-parker Blades
Run Serrated Saw through contactsRun Serrated Saw through contacts
1954N Strip (3M)1954N Strip (3M)
Epitex Strips (GC)Epitex Strips (GC)
15 micron finishing diamond (Brasseler))15 micron finishing diamond (Brasseler))
15 micron football-shaped diamond on lingual15 micron football-shaped diamond on lingual
OptraFine Porcelain polishing system (Ivoclar)OptraFine Porcelain polishing system (Ivoclar)
DiaShine ( V & H )DiaShine ( V & H )
Solid Model ContactsSolid Model Contacts
Adhesion to the restoration
Adhesion to the restoration
Ceramist etches in labClinician cleans internal
surfaces with phosphoric acidRinse and dry thoroughlyApply Silane coupling agentApply dual-cure adhesive
resin to internal of restoration
Ceramist etches in labClinician cleans internal
surfaces with phosphoric acidRinse and dry thoroughlyApply Silane coupling agentApply dual-cure adhesive
resin to internal of restoration
Adhesion to the restoration
Adhesion to the restoration
Ceramist etches in labClinician cleans internal
surfaces with phosphoric acidRinse and dry thoroughlyApply Silane coupling agentApply dual-cure adhesive
resin to internal of restoration
Ceramist etches in labClinician cleans internal
surfaces with phosphoric acidRinse and dry thoroughlyApply Silane coupling agentApply dual-cure adhesive
resin to internal of restoration
Blot Dry dentinBlot Dry dentin
Apply primerApply primer
Air dry primerAir dry primer
Light polymerize for 10 secondsLight polymerize for 10 seconds
PosteriorRelyX ARC (3M)PosteriorRelyX ARC (3M)
Hold passively for 3 minutesHold passively for 3 minutes
Remove excess with scaler or explorer
Remove excess with scaler or explorer
Floss through contactsFloss through contacts
Cover margins with oxygen-inhibiting medium
Cover margins with oxygen-inhibiting medium
Light polymerize for at least 60 seconds
Light polymerize for at least 60 seconds
Use scaler and/or #12 Bard Parker
Use scaler and/or #12 Bard Parker
Core-reinforced RestorationsZirconiaAluminaMetal
Lithium disilicate (e.Max)
Core-reinforced RestorationsZirconiaAluminaMetal
Lithium disilicate (e.Max)
Pressed Ceramic/Powder-liquid ceramics
Pressed Ceramic/Powder-liquid ceramics
“Total-etch” resin
cements
“Core” reinforced ceramic(Metal, zirconium, lithium disilicate, alumina oxide)
“Core” reinforced ceramic(Metal, zirconium, lithium disilicate, alumina oxide)
Conventional cements No etch Adhesive cements
High technique sensitivityHigh technique sensitivity
e.Max PressedLithium disilicate pressed
“Core” reinforced ceramic(Metal, zirconium, lithium disilicate, alumina oxide)
“Core” reinforced ceramic(Metal, zirconium, lithium disilicate, alumina oxide)
No etch Adhesive cements(Resin-ionomers, self-adhesive resin
cements)
Conventional cements(Zinc phosphate, polycarboxylate,
Glass ionomer)
“Core” reinforced ceramic(Metal, zirconium, lithium disilicate, alumina oxide)
“Core” reinforced ceramic(Metal, zirconium, lithium disilicate, alumina oxide)
Self-adhesive resin cements(Unicem, MaxCem, Multilink Automix, Panavia FL)
Resin Modified glass ionomers (FujiCem, FujiPlus, RelyX Luting)
No etch adhesive cements
“Self-adhesive” resin cements(the benefits of resin without the technique sensitivity)
“Self-adhesive” resin cements(the benefits of resin without the technique sensitivity)
Single component Self-Adhesive(Unicem, MaxCem, others)
Assisted Self-adhesive resin cements(Multilink Automix, Panavia FL)
“Single Component Self-adhesive “ cements“Single Component Self-adhesive “ cements
Embrace
Unicem (3M)MaxCem Elite (Kerr)Embrace Wetbond ( Pulpdent)
G-Cem (GC)BisCem (Bisco)
Unicem (3M)MaxCem Elite (Kerr)Embrace Wetbond ( Pulpdent)
G-Cem (GC)BisCem (Bisco)
“Single Component Self-adhesive “ cements“Single Component Self-adhesive “ cements
EmbraceBisCem (Bisco)
“Single Component Self-adhesive “ cements“Single Component Self-adhesive “ cements
Embrace
Bond strengths (Reality)
Dentin EnamelMaxCem 3.8 8.8
Unicem 7.7 16.6
BisCem 9.0 15.0
“Total-etch” 30.3 25.4 Relyx
Advantages of “Single Component self-adhesive” cements
Advantages of “Single Component self-adhesive” cements
Good physical properties Some adhesive properties
Very, very easy to use
Disadvantages of “Single Component self-adhesive” cements
Disadvantages of “Single Component self-adhesive” cements
Mediocre bonds to dentin and enamel
Questionable long term enamel bonds
Questionable bonds to restorative substrate
Assisted “Self-etch” resin cementsAssisted “Self-etch” resin cements
Panavia FL2.0(Kuraray)
Bistite II DC(J. Morita)
Multilink Automix(Ivoclar)
Advantages of Assisted “Self-adhesive” cements
Advantages of Assisted “Self-adhesive” cements
Good physical properties Good adhesive properties
Easier to use than “Total-etch” cements
Assisted “Self adhesive” cementsAssisted “Self adhesive” cements
Embrace
Bond strengths (Reality)
Dentin EnamelPanavia F 2.0 7.6 11.5
Bistite II 14.7 12.7
Multilink 15.1 16.4
“Total-etch” 30.3 25.4 Relyx
Involves an adhesive stepBonds not as strong as
“Total-etch”
Disadvantages of Assisted “Self-adhesive” cements
Disadvantages of Assisted “Self-adhesive” cements
Can we “etch “with phosphoric acid with self-etch cements?
Can we “etch “with phosphoric acid with self-etch cements?
Decreased bond strengths to dentin
Total-etch Self-etchPanavia F 2.0 18.3 11.8Unicem 16.6 8.5
Multilink 21.2 16.4
BisCem 15.0 13.8
Enamel Bonds
When do I use what?
When do I use what?Non-core supported ceramic:
“Total etch”Core-supported Ceramic
Minimal retention and resistance form?“Total-etch” with dual cure resin cement
Adequate retention and resistance?“self-adhesive” resin cements
Non-core supported ceramic:“Total etch”
Core-supported CeramicMinimal retention and resistance form?“Total-etch” with dual cure resin cement
Adequate retention and resistance?“self-adhesive” resin cements
Hornbrook 2009 Updates –
Full Day Events
Hornbrook 2009 Updates –
Full Day Events
November 6th – Albuquerque, NMNovember 13th – Boston, MA at Tufts University
Topics include:•2009 Materials Update•My top 10 failures and how YOU can avoid them! •Treatment Planning the Full Mouth Rehabilitation •Winning Case Presentation Techniques for a Tough Economy •Prepless Veneers: Necessary Addition to Your Restorative Arsenal •And much more!
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