Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
1
Resin luting cements
Five textbooks
Craig - Phillips
Art & Sciense
Contemporary fixed prosthodontics
Introduction to den...
2
Resin luting cements
Items to be covered
 Uses
 Types
 Types according to method of activation
 Light-cured
 Chemic...
3
1. Indirect restorations, including veneer, inlay, crown & bridge.
2. Posts: prefabricated posts.
3. Orthodontic bracket...
4
Contemporary: p. 779
Light-cured resin cements
 Less common, why? (Give reason)
 To avoid the potential incomplete pol...
5
than the self-cured or dual-cured versions.
 Uses: cementation of:
 Thin translucent prosthesis (ceramic & resin)
 Ce...
6
Unfilled resin (1950s)
 Without filler
 High polymerization shrinkage
 Poor biocompatibility
 Unsuccessful
Composite...
7
2. Adhesive chemical- / dual-cure resin cements
 Adhesive resin cement
 Improve the adhesive bond to metal
 Still req...
8
 MDP with Bis-GMA
 or 4-META & MMA in the liquid, and PMMA in the powder. (Craig)
Notes:
 MDP: Methacryloyloxydecyl d...
9
Conventional resin cement
 RelyX ARC (3M/ESPE)
Adhesive resin cement
 Super-Bond C&B (Sun Medical) → contains 4-META.
...
10
Contemporary: p. 780
Reaction
 Free radical polymerization reaction.
 Activator → activates the initiator → release f...
11
 Postoperative sensitivity
 Fluoride content & release
 Translucency & esthetics
 Bonding to the tooth structure
De...
12
Water sorption & solubility
 Virtually insoluble in oral fluids. (Phillips)
 Resin cements < resin-modified glass ion...
13
Fluoride content & release
 Self-adhesive resin cement:
 Low fluoride content (around 10%) less than glass ionomer & ...
14
Bonding to the tooth structure
 Micromechanical retention (interlocking) by acid etching.
 Chemical bond between acid...
15
Contemporary: p. 779
Phillips: p. 311
16
Manipulation
 The procedure for preparing tooth surfaces remains the same for each system.
 But the treatment of the ...
17
Introduction to dental materials: p. 223
 Self-adhesive resin cements have lower bond strength to etched glass-matrix ...
18
 HF etching does not improve the bond strength, why? (Give reason)
 Because polycrystalline ceramics do not contain a...
19
Contemporary: p. 780
Contemporary: p. 781
Resin-to-metal bonding (briefly)
20
 MDP & 4-META: the metal oxides on the surface of base metal & tin-plated noble alloys contributes
to the bond strengt...
21
Resin-to-resin bonding
 Introduction:(Introduction to dental materials, p. 229)
 One might imagine that resin-to-resi...
22
 Eugenol-free interim (temporary) luting agent should be used, why?
(Give reason)
 Because eugenol inhibits polymeriz...
Upcoming SlideShare
Loading in …5
×

Resin luting cements (Word)

Resin luting cements (Word)
A type of dental cement
Used for cementation of indirect restorations & brackets
A summary of five textbooks

Related Books

Free with a 30 day trial from Scribd

See all

Related Audiobooks

Free with a 30 day trial from Scribd

See all
  • Be the first to comment

Resin luting cements (Word)

  1. 1. 1 Resin luting cements Five textbooks Craig - Phillips Art & Sciense Contemporary fixed prosthodontics Introduction to dental materials
  2. 2. 2 Resin luting cements Items to be covered  Uses  Types  Types according to method of activation  Light-cured  Chemical-cured  Dual-cured  Types according to development & the presence of filler  Unfilled resin  Composite resin cement  Types according to adhesion  Conventional  Adhesive  Self-adhesive  Composition  Reaction  Properties  Degree of conversion  Cytotoxicity  Mechanical properties  Water sorption & solubility  Film thickness  Postoperative sensitivity  Fluoride content & release  Translucency & esthetics  Bonding to the tooth structure  Manipulation  Resin-to-tooth bonding  Resin-to ceramic bonding  Resin-to-metal bonding  Resin-to-resin bonding Uses (applications) Cementation of: References Craig's restorative dental materials Sturdevant's art and science of operative dentistry Contemporary fixed prosthodontics Introduction to dental materials Phillips' science of dental materials
  3. 3. 3 1. Indirect restorations, including veneer, inlay, crown & bridge. 2. Posts: prefabricated posts. 3. Orthodontic brackets. Note: orthodontic bands are commonly cemented by glass ionomer cements (GIC). (Phillips) 4. Different types of materials, including:  Ceramics  Resin composites: laboratory-processed (indirect)  Metals: if extra retention is needed 5. Resin cements are the material of choice for cementation of ceramic veneers (restorations), why? (Give reason)  Translucent, good esthetics & various shades.  Reduce fracture incidence of ceramics:  High strength & good bond strength. Types according to the method of activation 1. Light-cured 2. Chemical-cured (self-cured) 3. Dual-cured: combination of chemical & light activation
  4. 4. 4 Contemporary: p. 779 Light-cured resin cements  Less common, why? (Give reason)  To avoid the potential incomplete polymerization under a prosthesis.  Not cure (polymerize) properly with large inlays & crowns, why?(Give reason)  Light would be unable to penetrate to the full depth of inlay & crown.  Recommended for bonding the veneer, why? (Give reason)  More color stability  More working time
  5. 5. 5 than the self-cured or dual-cured versions.  Uses: cementation of:  Thin translucent prosthesis (ceramic & resin)  Ceramic veneers  Orthodontic brackets (Craig) Chemical-cured resin cement  Uses: cementation of:  All types of restorations. (Phillips)  Metal (cast) restorations: if extra retention is needed.  Translucent restorations with thickness more than 2.5 mm. (Phillips, p. 330)  Inlays: chemical polymerization is preferred, why? (Give reason)  To ensure maximum polymerization in the less accessible proximal areas.  Clinical performance: chemical-cured > dual-cured. (Contemporary: p. 784) Dual-cured resin cement  Most commercial products  Suitable working time  High degree of conversion even in areas not reached by light. (Craig)  Slow reaction until exposed to light → at which point the cement hardens rapidly.  Uses: cementation of translucent restorations with thickness less than 2.5 mm. (Phillips, p. 330)
  6. 6. 6 Unfilled resin (1950s)  Without filler  High polymerization shrinkage  Poor biocompatibility  Unsuccessful Composite resin cement  Contains filler.  Greatly improve properties.  ↑ filler loading (content) → ↓ resin content → ↓ problems of resin, such as ↓ polymerization shrinkage.  The filler loading (content) is lower than composite restorative material, why? (Give reason)  To ensure low film thickness (required for cementation). Types of resin cements (Introduction to dental materials, p. 221) 1. Aesthetic light- / dual-cure composite resins (conventional) 2. Adhesive chemical- / dual-cure resin cements 3. Self-adhesive dual-cure resin cements 1. Aesthetic light- / dual-cure composite resins  Conventional resin cement  Not adhesive  Used when aesthetic is important
  7. 7. 7 2. Adhesive chemical- / dual-cure resin cements  Adhesive resin cement  Improve the adhesive bond to metal  Still require a dentin bonding agent 3. Self-adhesive dual-cure resin cements  Self-adhesive resin cement  Etching, priming & bonding in a single material. (Craig) = Single step application (Introduction to dental materials, p. 222) = Not require any pretreatment of the tooth. (Art & Science, p. 159) = Not require etching & bonding (Phillips) = Avoid the need for separate etching & bonding. (Craig)  Simultaneous adhesion to tooth & restoration.  Become popular, why? (Give reason)  Simpilicity  Lowest post-cementation sensitivity.  Universal adhesive.  Good bond strength to dentin. (contemporary, p. 781) Composition Conventional resin cement  Very similar composition to restorative composites. (Craig)  Four major components:  Organic resin matrix  Inorganic filler  Silane coupling agent  Initiator-accelerator system Adhesive resin cement  Combine:
  8. 8. 8  MDP with Bis-GMA  or 4-META & MMA in the liquid, and PMMA in the powder. (Craig) Notes:  MDP: Methacryloyloxydecyl dihydrogen phosphate.  4-META: Methacryloxyethyl trimellitic anhydride.  Bond chemically to metal oxides.  High affinity of carboxylic acid & phosphoric acid derivative-containing resins for metal oxides. Self-adhesive resin cement  Acidic functional monomer:  Etch the tooth.  Based on phosphates & phosphonates.  Bond to base metal alloys (metal oxides) & ceramics.  Simultaneous adhesion to tooth & restoration  Examples:  10-MDP: Methacryloyloxydecyl dihydrogen phosphate.  Penta-P: dipentaerythritol pentacrylate phosphate.  Glycerol dimethacrylate dihydrogen phosphate.  Alkaline glass: acid neutralizing fillers, such as fluoroalumino silicate (found in glass ionomers).  Note: the remaining acidity is neutralized by alkaline glass. (Craig)  Alkaline amines become inactive in an acidic environment.  Therefore, a new initiator system has to be developed.  Each product has its own acid-resistant initiator/accelerator system. (Introduction to dental materials, p. 222,223) Commercial products
  9. 9. 9 Conventional resin cement  RelyX ARC (3M/ESPE) Adhesive resin cement  Super-Bond C&B (Sun Medical) → contains 4-META.  Panavia 21 (Kurary) → contains MDP. Self-adhesive resin cement  RelyX Unicem (3M/ESPE): contains phosphoric acid-modified methacrylates  SmartCem2 (Dentsply): contains PENTA.  MaxCem Elite (Kerr):contains glycerol dimethacrylate dihydrogen phosphate  Panavia SA Cement Plus (Kurary): contains MDP.  Speed CEM Plus (Ivoclar Vivadent): contains MDP.  Solocem (Coltene): contains MDP & 4-META. Structure of MDP
  10. 10. 10 Contemporary: p. 780 Reaction  Free radical polymerization reaction.  Activator → activates the initiator → release free radical → initiate the polymerization reaction.  Acidic groups (phosphate & carboxylate) bind with calcium in hydroxyapatite.  At later stages, the remaining acidity is neutralized by alkaline glass.  Anaerobic setting reaction:  Some commercial products do not set in the presence of oxygen.  Oxygen barrier (protection): a polyethylene glycol gel (Oxyguard II) can be placed over the restoration margins  Oxygen barrier (protection).  To ensure complete polymerization. (Contemporary, p. 708) Properties  Degree of conversion  Cytotoxicity  Mechanical properties  Water sorption & solubility  Film thickness
  11. 11. 11  Postoperative sensitivity  Fluoride content & release  Translucency & esthetics  Bonding to the tooth structure Degree of conversion  In dual-cured cements:  Light-curing → ↑ degree of conversion →  ↑ mechanical properties  ↓ residual monomer → ↓ cytotoxicity of dual-cured cements. Cytotoxicity  Unfilled resin > composite resin cement, why? (Give reason)  In dual-cured resin cements, light-curing → ↓ cytotoxicity, why? (Give reason)  After 7 days, Bis-GMA-based dual-cured cements are less cytotoxic than zinc polyacrylate.  Adhesive resin cements are less biocompatible than glass ionomer cement, especially if they (resin cements) are not fully polymerized.  Pulp protection: important when the thickness of remaining dentin is less than 0.5 mm.  In self-adhesive resins: slightly acid-soluble glass filler reacts with the acidic monomer → increases the pH to a neutral level. (Introduction to dental materials, p. 222) Mechanical properties  Compressive strength:  Resin cements (dual- & light-cured) > acid-base cements.  ↑ Filler content & ↑ degree of conversion → ↑ mechanical properties.  In dual-cured resin cements, light-curing → ↑ mech prop, why? (Give reason)  Self-adhesive resin cements have slightly (somewhat) lower mechanical properties than conventional resin cements.
  12. 12. 12 Water sorption & solubility  Virtually insoluble in oral fluids. (Phillips)  Resin cements < resin-modified glass ionomer. Notes:  However, discoloration of the cement line may occur after a prolonged period. (Craig)  Shrinkage: 2–5%.  Water sorption:  Self-adhesive resin cement > conventional, why? (Give reason)  Unreacted acid groups → ↑ water sorption. (Craig) Film thickness  Low viscosity & film thickness. (Craig & Phillips)  The filler loading (content) is lower than composite restorative material, why? (Give reason)  To ensure low film thickness. (Introduction to dental materials, p. 225) Postoperative sensitivity  = Post-cementation sensitivity = Post-treatment sensitivity. (Contemporary: p. 778, 781)  Self-adhesive resins:  Lowest incidence of post-cementation sensitivity, why? (Give reason)  Because the dentin does not need to be etched with phosphoric acid. (Craig)  Significant advantage.
  13. 13. 13 Fluoride content & release  Self-adhesive resin cement:  Low fluoride content (around 10%) less than glass ionomer & resin-modified glass ionomer.  Fluoride release:  Decrease rapidly with time.  Its beneficial effects have not been clinically proven. Translucency & esthetics  Various shades & translucencies.  Amines degrade over time, altering the shade of the cement. (Craig)  Discoloration of the cement line may occur after a prolonged period. (Craig)  Note: resin cements are the material of choice for cementation of ceramic veneers (restorations), why? (Give reason)  Self-adhesive resin cement is not recommended for bonding of ceramic veneers, why? (Give reason)  Ceramic veneers are cemented by light-cured resin cements.  Because of the need for high esthetics. (Introduction to dental materials, p.223)
  14. 14. 14 Bonding to the tooth structure  Micromechanical retention (interlocking) by acid etching.  Chemical bond between acidic groups (if present) & calcium in tooth structure.  Self-adhesive resin cement:  Simultaneous adhesion to tooth & restoration.  Etching, priming & bonding to tooth in a single material. (Craig) = Single step application (Introduction to dental materials, p. 222) = Not require any pretreatment of the tooth. (Art & Science, p. 159) = Not require etching & bonding (Phillips) = Avoid the need for separate etching & bonding. (Craig)  Acidic functional monomer:  Etch the tooth.  Based on phosphates & phosphonates.  Bond to tooth, base metal alloys (metal oxides) & ceramics.  Simultaneous adhesion to tooth & restoration.  Bond strength to dentin: comparable to resin cements.  Bond strength to enamel: less than conventional resin cements.  Selective etching (with phosphoric acid gel to enamel only) → ↑ bond strength to enamel.  Notes: enamel bonds are compromised with most self-etching primers.  This deficiency may be overcome using the “selective etch” technique. (Art & Science, p. 482)  Self-adhesive resin cement is not suitable for bonding of orthodontic brackets, why? (Give reason)  Because bonding to enamel is less than that achieved with the etch-and-rinse & self-etching dentin-bonding agents. (Introduction to dental materials, p.223)
  15. 15. 15 Contemporary: p. 779 Phillips: p. 311
  16. 16. 16 Manipulation  The procedure for preparing tooth surfaces remains the same for each system.  But the treatment of the prosthesis differs depending on the composition of the prosthesis. (Phillips) Resin-to-tooth bonding  Etch-and-rinse or self-etch bonding systems.  Etch-and-rinse:  Phosphoric acid etching (35–37%), then rinsing & gentle drying.  Bonding agent application → form resin tags → ready for luting of restoration with resin cement.  Self-adhesive resin cements do not require etching & bonding. Resin-to ceramic bonding  Silica-based or glass-matrix ceramics:  Examples: feldspathic porcelain, leucite-reinforced & lithium disilicate-reinforced ceramics.  Hydrofluoric (HF) acid etching (5–10%), rinsing & air-drying.  Silane coupling agent is applied.  After try-in & prior to applying the silane, cleaning the ceramic surface with isopropyl alcohol, acetone or phosphoric acid is needed.  To remove any surface contaminants, such as saliva. (Introduction to dental materials, p.224)  For some silane products, it is recommended that a phosphoric acid solution is added to the silane to hydrolyse it prior to its application.  Other silane products are already hydrolysed with limited shelf life. (Introduction to dental materials, p.224)  Resin cements are the luting agent of choice, why? (Give reason)
  17. 17. 17 Introduction to dental materials: p. 223  Self-adhesive resin cements have lower bond strength to etched glass-matrix ceramics than conventional resin cements. (Art & Science, p. 159)  Oxygen barrier (protection): some products of resin cements do not set in the presence of oxygen (anaerobic setting reaction), such as Panavia 21.  A polyethylene glycol gel (Oxyguard II) can be placed over the restoration margins → Oxygen barrier (protection). → To ensure complete polymerization.  Note: sandblasting with alumina particles (airborne-particle abrasion): * Immediate lower the flexural strength of feldspathic porcelains & lithium disilicate-reinforced ceramics. * ↓ bond strength when HF is not used. (Art & Science, p. 158)  The primary source of retention remains the etched porcelain itself.  Silanation → only a modest ↑ in bond strength.  However, silanation is recommended, why? (Give reason) → ↓ marginal leakage & discoloration. (Art & Science, p. 297)  Polycrystalline ceramics:
  18. 18. 18  HF etching does not improve the bond strength, why? (Give reason)  Because polycrystalline ceramics do not contain a glass matrix. (Art & Science, p. 158)  Newest protocols: (Art & Science, p. 158)  Airborne-particle abrasion.  Tribochemical silica coating, followed by silane application.  Primers or silane mixed with functional monomers, such as 10-MDP.  Micromechanical retention plays more important role than chemical bonding.(Art & Science, p. 158)  Zirconia restorations:  Should be cemented with resin-modified glass ionomer or self-adhesive resin cement. (Art & Science, p. 508)  MDP-based resin cements → ↑ adhesion to zirconia.  Sandblasting is controversial.  There is a definite risk in the use of air particle abrasion, why? (Give reason) → conversion to monoclinic & substantial weakening. (Art & Science, p. 508)  Air abrasion with alumina, followed by MDP-based self-adhesive resin cements → form stable Zr–O–P bonds on the zirconia surface & improve its bond strength. (Craig, p. 281,282)  Tribochemical coating using silica-modified alumina particles, followed by silanization is also efficient. (Craig, p. 281)  The combination of mechanical and chemical pretreatment is recommended for bonding to zirconia. (Art & Science, p. 158) A note on zirconia restorations  Try-in → contamination with saliva.  Zirconia has a strong affinity for proteins found in saliva & blood.  These proteins cannot be removed with phosphoric acid.  NaOH solution (Ivoclean, Ivoclar Vivadent), for 20 seconds, remove these proteins. (Art & science p. 508)
  19. 19. 19 Contemporary: p. 780 Contemporary: p. 781 Resin-to-metal bonding (briefly)
  20. 20. 20  MDP & 4-META: the metal oxides on the surface of base metal & tin-plated noble alloys contributes to the bond strength (chemical bond) when resin cements contain MDP or 4-META. (Phillips)  Tin plating improves the retention of noble alloys, why? (Give reason)  Noble alloys → lack of metal oxide on the surface.  Tin plating → tin can form tin oxide on the surface.  Metals are best prepared by sandblasting (airborne-particle abrasion) with alumina particles  ↑ retention by 64%. (Contemporary, p. 781)  Creates a roughened higher surface area for bonding.  Alumina coating → aids in oxide bonding of Phosphate-based adhesive system. (Contemporary, p. 697)  Tribochemical silica coating (blasting with silica-coated alumina particles), followed by silane application is adequate.  However, it is generally confined to bonding composite resin veneers to alloy castings, why? (Give reason)  Because the silane-treated surface may become contaminated before or during the clinical bonding procedures. (Contemporary, p. 698)  Types: (Introduction to dental materials, p. 227)  Rocatec: laboratory-based system  Cojet: chair-side system  Disadvantages: (Introduction to dental materials, p. 228)  Multiple steps → ↑ likelihood of errors.  Need special equipment.  Metal primers are developed, but the research results are inconsistent. (Craig, 280)  Electrolytic etching is not popular, why? (Give reason)  Requires high degree of skill & special equipments. (Introduction to dental materials, p. 225)  Note: alloy etching and macroscopic retention mechanisms have become obsolete. (Contemporary, p. 697)
  21. 21. 21 Resin-to-resin bonding  Introduction:(Introduction to dental materials, p. 229)  One might imagine that resin-to-resinbonding should be free of problems, this is, in fact, not the case.  In particular, there have been problems of debonding between the luting resin & composite inlay.  Oxygen inhibitionlayer does not exist.  The luting resin has to bond directly to fully cured resins.  This is similar to repairing a fractured composite restoration with new composite resin.  Roughened by grit-blasting (alumina sandlasting).  Phosphoric acid etching → clean the debris from the surface.  HF acid is not recommended, why? (Give reason)  HF causes degradation of the composite surface by etching away the silica glass → leaving a weak & porous polymer matrix. (Craig, p. 282)  Tribochemical technique → silica layer, then silane application.  The problem of resin-to-resin bonding has not yet been resolved satisfactorily, & thus will continue to be an area of research interest. (Introduction to dental materials, p. 229) A note on “try-in” pastes (Craig & Phillips)  Same shade as the resin cement.  Help with shade selection.  Glycerin-based.  Water-soluble.  After shade selection → rinsed away with water spray. A note on temporary cementation
  22. 22. 22  Eugenol-free interim (temporary) luting agent should be used, why? (Give reason)  Because eugenol inhibits polymerization of the resin. References Sakaguchi R, Ferracane J, Powers J. Craig's restorative dental materials. 14th ed. St. Louis, Elsevier; 2019. p. 280–282, 289–292. Ritter AV, Boushell LW, Walter R. Sturdevant's art and scienceof operative dentistry. 7th ed. St. Louis, Elsevier; 2019. p. 157–159, 297, 443, 482, 508. Rosenstiel SF, Land MF, Fujimoto J. Contemporary fixed prosthodontics. 5th ed. St. Louis, Elsevier; 2016. p. 691, 696–698, 708, 777–781, 784. Van Noort R, Barbour ME. Introduction to dental materials. 4th ed. Mosby Elsevier; 2013. p. 221–229. Anusavice KJ, Shen C, Rawls HR. Phillips' science of dental materials. 12th ed. St. Louis, Elsevier; 2013.p. 311, 329, 330.

×