Advanced Cementation Update Webinar

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Advanced Cementation Update Webinar
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Clinical Mastery (www.clinicalmastery.com)

• Over-the-shoulder Prepless veneer courses
• Full mouth rehabilitation courses
• Hands-on Occlusion Courses
• Webinars
• Phoenix, Arizona

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WebinarOctober 14th
The Why, Where, When of bite relationships

• John Nosti, DMD

www.clinicalmastery.com
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david_at_hornbrook.com
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Cementation

• Adhesion
• total-etch, resin cement
• Semi-adhesion
• Self-etching resin cement
• Non-adhesion
• Glass Ionomer, resinionomer, zinc phosphate,
  polycarboxylate

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Cement Requirements

• Lack of post-operative sensitivity
• Strong bond and good seal
• -to the tooth and to the restorative material
• Easy placement and clean-up
• Esthetics compatible with the restorative
  material
• Minimal film thickness
• Radiopaque (posterior)

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Total-etchwith Resin Cement

• Powder liquid ceramic
• or
• Pressed ceramic restorations

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Tack Wave Cementation
Veneers and anterior crowns
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Emprethin evaluation
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Be Careful!!!

• 0.2 mm glass is fragile!

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OptraGate (Ivoclar)
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Hydrogen Peroxide in Ultradent Syringe
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Metal strip removes any interproximal Luxatemp
and freshens the enamel
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Try in independently DRY
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Occlude Spray Powder (Pascal)
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Try-in collectively DRY!

• Check complete seating
• Proximal contacts

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Mesial Surface
Dry Erase Marker
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Distal Surface
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Variolink Veneer(Ivoclar/Vivadent)

• Value based
• 0
• 1, 2, 3
• -1, -2, -3
• Microfill

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2
0
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Clean and acidify with 35 Phosphoric acid
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Silane Coupling Agent (Relyx Ceramic primer)
placed for 1 minute
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Place bonding agent (All Bond 3) inside dry
restoration
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Load restoration with resin cement
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Vivapad (Ivoclar)
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Etch with 35 phosphoric acid for 15 seconds per
tooth
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Apply Systemp desensitizer for 15 seconds
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Effect of Remoistening
Water vs. Desensitizer/Rewetting Agent
Dentinal Bond
Product

• 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

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suction away excess do not desiccate
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Apply 2 coats of All Bond 3 A B Primer mix
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Adec Warm Air Tooth Dryer
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Seat all restorations at one time do not remove
excess resin cement
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Polymerize dead center each restoration for 1
second using a 2.0 mm light guide (Ivoclar)
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Hold light guide 1 inch from restorations and
light cure 3-5 seconds on facial and lingual
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General Guidelines

• 2 5 seconds
• 0 3 seconds
• -3 5 seconds

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Pick" away excess using Bard Parker or scaler
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Floss through contacts using a Brasseler Serrated
Saw
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Floss through contacts using waxed dental floss
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Place DeOx (Ultradent) on all margins
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Light polymerize for at least 60 seconds per
tooth from both buccal and lingual
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Curing Lights

• Photoinitiators
• Camphoroquinone- 470-490 nm
• PhenylDipropandione- 430 nm

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CQ 488 nm
PDP 430 nm
Wavelength (nm)
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OptiLux 501 (Demetron)
Emits light with wavelength 390-510 nm
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CQ 488 nm
PDP 430 nm
Wavelength (nm)
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LED Lighti.e.. Freelight (3M), LEDemetron
(Kerr),,BluPhase (Ivoclar), DEMI (Kerr)
-No bulb degradation -Portable -Wavelength output
450-500 nm
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CQ 468 nm
PDP 430 nm
Wavelength (nm)
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Emits light with wavelength 390-510 nm
BluePhase G2 (Ivoclar)
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Fusion www.dentlight.com
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Remove excess resin cement with Scaler, 12
15 Bard-parker Blades
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Run Serrated Saw through contacts
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1954N Strip (3M)
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Epitex Strips (GC)
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15 micron finishing diamond (Brasseler))
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15 micron football-shaped diamond on lingual
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OptraFine Porcelain polishing system (Ivoclar)
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DiaShine ( V H )
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Solid Model Contacts
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Adhesion to the restoration

• Ceramist etches in lab
• Clinician cleans internal surfaces with
  phosphoric acid
• Rinse and dry thoroughly
• Apply Silane coupling agent
• Apply dual-cure adhesive resin to internal of
  restoration

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Adhesion to the restoration

• Ceramist etches in lab
• Clinician cleans internal surfaces with
  phosphoric acid
• Rinse and dry thoroughly
• Apply Silane coupling agent
• Apply dual-cure adhesive resin to internal of
  restoration

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Blot Dry dentin
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Apply primer
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Air dry primer
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Light polymerize for 10 seconds
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Posterior RelyX ARC (3M)
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Hold passively for 3 minutes
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Remove excess with scaler or explorer
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Floss through contacts
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Cover margins with oxygen-inhibiting medium
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Light polymerize for at least 60 seconds
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Use scaler and/or 12 Bard Parker
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• Core-reinforced Restorations
• Zirconia
• Alumina
• Metal
• Lithium disilicate (e.Max)

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Core reinforced ceramic (Metal, zirconium,
lithium disilicate, alumina oxide)
Pressed Ceramic/ Powder-liquid ceramics
High technique sensitivity

• Conventional cements
• No etch Adhesive cements

• Total-etch resin cements

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e.Max Pressed Lithium disilicate pressed
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Core reinforced ceramic (Metal, zirconium,
lithium disilicate, alumina oxide)

• Conventional cements
• (Zinc phosphate, polycarboxylate,
• Glass ionomer)

• No etch Adhesive cements
• (Resin-ionomers, self-adhesive resin cements)

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Core reinforced ceramic (Metal, zirconium,
lithium disilicate, alumina oxide)
No etch adhesive cements

• Resin Modified glass ionomers
• (FujiCem, FujiPlus, RelyX Luting)

• Self-adhesive resin cements
• (Unicem, MaxCem, Multilink Automix, Panavia FL)

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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)

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Single Component Self-adhesive cements

• Unicem (3M)
• MaxCem Elite (Kerr)
• Embrace Wetbond ( Pulpdent)
• G-Cem (GC)
• BisCem (Bisco)

Embrace
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Single Component Self-adhesive cements
BisCem (Bisco)
Embrace
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Single Component Self-adhesive cements
Bond strengths (Reality)
Dentin
Enamel
Embrace
MaxCem 3.8
8.8
Unicem 7.7
16.6
BisCem 9.0
15.0
Total-etch 30.3
25.4 Relyx
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Advantages of Single Component self-adhesive
cements

• Good physical properties
• Some adhesive properties
• Very, very easy to use

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Disadvantages of Single Component
self-adhesive cements

• Mediocre bonds to dentin and enamel
• Questionable long term enamel bonds
• Questionable bonds to restorative substrate

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Assisted Self-etch resin cements
Panavia FL2.0 (Kuraray)
Bistite II DC (J. Morita)
Multilink Automix (Ivoclar)
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Advantages of Assisted Self-adhesive cements

• Good physical properties
• Good adhesive properties
• Easier to use than Total-etch cements

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Assisted Self adhesive cements
Bond strengths (Reality)
Dentin
Enamel
Embrace
Panavia 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
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Disadvantages of Assisted Self-adhesive cements

• Involves an adhesive step
• Bonds not as strong as Total-etch

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Can we etch with phosphoric acid with self-etch
cements?
Total-etch
Self-etch
Enamel Bonds
Panavia F 2.0 18.3 11.8
Unicem 16.6
8.5
Multilink 21.2
16.4
BisCem 15.0
13.8
Decreased bond strengths to dentin
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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

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Hornbrook 2009 Updates Full Day Events

• 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!

November 6th Albuquerque, NM November 13th
Boston, MA at Tufts University