Lecture 8: Biomaterials (Cements) **By Dr Cheryl Fu** THE UNIVERSITY of WESTERN AUSTRALIA Lecture 8: Biomaterials (Cements) **By Dr Cheryl Fu** # Learning Objectives The University of Western Australia - Different permanent and temporary cements and their uses - Bonding/luting mechanisms - Clinical steps for cementing a permanent crown (glassy vs crystalline vs metallic) Reading: Chapter 30 Contemporary fixed prosthodontics + Dental Luting Cements: An Updated Comprehensive Review Artak Hebayan<sup>1,*</sup>, Anna Vardanian<sup>1</sup>, Mohmed Isaqali Karobari<sup>2,3</sup>, Anand Marya<sup>4,5</sup>, Tavayk Avagyan<sup>6</sup>, Hamid Tebyaniyan<sup>7</sup>, Mohammed Mustafa<sup>8</sup>, Dinesh Rokaya<sup>9,*</sup> and Anna Avetisyan<sup>10</sup> _figures/img_9ae4b51f30c56537.webp) #### Core Competencies - Different permanent and temporary cements and their uses - Bonding/luting mechanisms - Clinical steps for cementing a permanent crown (glassy vs crystalline vs metallic) #### Recommended Reading - Contemporary Fixed Prosthodontics, Chapter 30 - Dental Luting Cements: An Updated Comprehensive Review; Artak Hebayan, Anna Vardanian, Mohmed Isaqali Karobari, Anand Marya, Tavayk Avagyan, Hamid Tebyaniyan, Mohammed Mustafa, Dinesh Rokaya, and Anna Avetisyan University logo for The University of Western Australia. # Cements **THE UNIVERSITY OF WESTERN AUSTRALIA** Divided into temporary and permanent cements • Temporary cements such as zinc oxide eugenol/eugenol free cements covered in temporization Permanent cements can then be classified in many ways: • **Composition:** • Resin based vs Water based (GIC, zinc polycarboxylate and zinc phosphate) • **Bonding mechanism** • Non adhesive luting vs micromechanical retention vs molecular adhesion Dental cements are broadly categorized based on their intended duration of use and their chemical properties. #### Duration of Use - **Temporary Cements:** These include zinc oxide eugenol and eugenol-free formulations, typically utilized during the temporization phase. - **Permanent Cements:** These are intended for long-term restoration and are further classified by composition and bonding mechanism. #### Classification of Permanent Cements - **By Composition:** - Resin-based cements - Water-based cements (e.g., Glass Ionomer Cement [GIC], zinc polycarboxylate, and zinc phosphate) - **By Bonding Mechanism:** - Non-adhesive luting - Micromechanical retention - Molecular adhesion **A Review of Dental Cements** **Kipp Wingo, DVM, DAVDC** **Luting** “A term sometimes used to refer to final placement of a fixed prosthodontic restoration is to “lute” the restoration. It derives from the Latin lutum, which means mud or clay. A “luting agent” is the substance—such as cement, wax, or clay—that coats a joint area to make a tight seal. Historically, luting agents were used to mechanically link restorations to a prepared tooth.” Luting cements work based of mechanical friction by Traditionally for cast restorations The luting cement powder sets into a hardened matrix However luting cements generally have solubility issues due to the matrix consisting of ionic salts _figures/img_00d0290a5fd01914.webp) The term "lute" originates from the Latin *lutum*, meaning mud or clay. In a clinical context, a luting agent is a substance—such as cement, wax, or clay—applied to a joint area to create a tight seal. Historically, these agents were used to mechanically link restorations to a prepared tooth. #### Mechanism of Action - Luting cements function primarily through mechanical friction. - They are traditionally used for the final placement of cast restorations. - During the setting process, the cement powder transforms into a hardened matrix. #### Clinical Considerations - Luting cements often present solubility issues because their matrix consists of ionic salts. Photo of a roll of abrasive sandpaper with the surface unrolled. A red arrow points to the top edge of the paper roll. The context identifies this as an illustration of 'mud or clay' (lutum), which is historically used as a luting agent. **Micromechanical bonding** - Resin cements - Etching dentin/enamel (Phosphoric acid) - Etching glassy ceramics (hydrofluoric acid) - Sand blasting metal/zirconia crowns Micromechanical bonding is a primary retention mechanism for resin cements and involves specific surface treatments for different restorative materials: - **Dentin and Enamel:** Prepared using phosphoric acid etching. - **Glassy Ceramics:** Prepared using hydrofluoric acid etching. - **Metal and Zirconia Crowns:** Prepared via sandblasting. **Molecular adhesion** * Physical forces such Van der Waals or chemical ionic bonding. * 10-MDP * At the moment cements still require other methods of retention (parallel walls) * Can not rely solely on this. Molecular adhesion involves the use of physical forces or chemical interactions to secure a restoration. #### Adhesion Principles - Utilizes physical forces such as Van der Waals forces or chemical ionic bonding. - Employs functional monomers such as 10-MDP. #### Clinical Limitations - Current cement technology cannot rely solely on molecular adhesion for retention. - Supplemental methods of retention, such as maintaining parallel preparation walls, remain necessary. # Ideal Properties of Cements **The University of Western Australia** * Low film thickness * Suitable working time and setting time * High compressive strength * Similar elastic modulus as dentin * Biocompatible * Plaque/caries inhibition * Low solubility * Low microleakage * Easy removal of excess * High retention #### Characteristics of an Ideal Luting Agent - Low film thickness - Suitable working time and setting time - High compressive strength - Similar elastic modulus as dentin - Biocompatible - Plaque/caries inhibition - Low solubility - Low microleakage - Easy removal of excess - High retention # Biocompatible and Antimicrobial Effects * Cements should ideally not interact with bodily tissues, and not cause sensitivity or allergic reactions * Antimicrobial effects to prevent marginal caries. However evidence in inconclusive whether low level fluoride or other antimicrobial agents can provide long term inhibition. (Will the fluoride etc still be there in 10 years?) #### Tissue Interaction and Sensitivity - Cements should ideally not interact with bodily tissues, and not cause sensitivity or allergic reactions. #### Antimicrobial Properties - Antimicrobial effects are desired to prevent marginal caries. - Evidence is inconclusive regarding whether low-level fluoride or other antimicrobial agents provide long-term inhibition (e.g., effectiveness over a 10-year period). **Suitable working and setting time** • Ideally enough time to mix the cement, seat and clean up excess in appropriate time • Benefit of tack cure resin cement. • However if excess resin cement is not fully removed before final cure, will be extremely hard to remove excess #### Clinical Handling - Ideally, there should be enough time to mix the cement, seat the restoration, and clean up excess in an appropriate timeframe. - Tack cure resin cements offer clinical benefits for efficiency. - **Caution:** If excess resin cement is not fully removed before the final cure, it becomes extremely difficult to remove. # **Microleakage/Solubility** * Solubility of cements in the oral environment (water) can lead to **microleakage** at the marginal interface and possible loss of retention. * **Zinc** phosphate and **zinc** polycarboxylate have high solubility * **Resin** cements have low solubility _figures/img_315d33327614d476.webp) #### Impact of Solubility on Retention - Solubility of cements in the oral environment (water) can lead to microleakage at the marginal interface and possible loss of retention. - **Zinc phosphate and zinc polycarboxylate:** High solubility. - **Resin cements:** Low solubility. University logo for The University of Western Australia. ## Microleakage/Solubility ### Mean and standard deviation values of microleakage of the cements in restorations with open margins (mm) | Cement | N | Mean ± SD | | :--- | :--- | :--- | | Fleck | 15 | **3.32 ± 0.70** | | Fuji Plus | 15 | 0.92 ± 0.53 | | G-Cem | 15 | 2.08 ± 1.10 | | Panavia F2.0 | 15 | **0.64 ± 0.78** | | **Total** | **60** | **1.74 ± 1.32** | ### Mean and Standard Deviation Values of Microleakage of the Cements in Restorations With Closed Margins (mm) | Cement | N | Mean ± SD | | :--- | :--- | :--- | | Fleck | 15 | **1.92 ± 1.23** | | Fuji Plus | 15 | 0.77 ± 0.88 | | G-Cem | 15 | 1.25 ± 1.07 | | Panavia F2.0 | 15 | **0.18 ± 0.14** | | **Total** | **60** | **1.03 ± 1.11** | **Fleck = zinc phosphate** **HOWEVER ITS NOT** **APPROPRIATE TO** **SAY RESIN CEMENTS** **ARE PERFECT** --- **Microleakage of Four Dental Cements in Metal Ceramic Restorations With Open Margins** Reza Eftekharp Ashtiani, Babak Fanzaneh, Mohadese Azarsina, Farzad Aghdashi, Nima Dehghani, Aisooda Afshari, and Minu Mahmud _figures/img_807a2dc714e37b2f.webp) _figures/img_ce5b22be3914a57a.webp) #### Comparative Microleakage Data **Microleakage in Restorations with Open Margins (mm)** | Cement | N | Mean ± SD | | :--- | :--- | :--- | | Fleck (Zinc Phosphate) | 15 | 3.32 ± 0.70 | | Fuji Plus | 15 | 0.92 ± 0.53 | | G-Cem | 15 | 2.08 ± 1.10 | | Panavia F2.0 | 15 | 0.64 ± 0.78 | | **Total** | **60** | **1.74 ± 1.32** | **Microleakage in Restorations with Closed Margins (mm)** | Cement | N | Mean ± SD | | :--- | :--- | :--- | | Fleck (Zinc Phosphate) | 15 | 1.92 ± 1.23 | | Fuji Plus | 15 | 0.77 ± 0.88 | | G-Cem | 15 | 1.25 ± 1.07 | | Panavia F2.0 | 15 | 0.18 ± 0.14 | | **Total** | **60** | **1.03 ± 1.11** | *Note: While resin cements show lower microleakage, they are not considered perfect in all clinical scenarios.* Table titled 'Mean and standard deviation values of microleakage of the cements in restorations with open margins (mm)'. Columns: Cement, N, Mean ± SD. Rows list four cements: Fleck (3.32 ± 0.70), Fuji Plus (0.92 ± 0.53), G-Cem (2.08 ± 1.10), Panavia F2.0 (0.64 ± 0.78), and Total (1.74 ± 1.32). Blue arrows point to the Fleck and Panavia F2.0 rows, highlighting their values. Table titled 'Mean and Standard Deviation Values of Microleakage of the Cements in Restorations With Closed Margins (mm)'. Columns: Cement, N, Mean ± SD. Rows list four cements: Fleck (1.92 ± 1.23), Fuji Plus (0.77 ± 0.88), G-Cem (1.25 ± 1.07), Panavia F2.0 (0.18 ± 0.14), and Total (1.03 ± 1.11). Blue arrows point to the Fleck and Panavia F2.0 rows, highlighting their values. Film thickness **[Influence of types and surface treatment of dental alloy and film thickness of cements on bond strength of dental luting cements].** **Hibino Y1** Table 4 Correlation coefficients between film thickness and tensile bond strength of dental luting cements|Cement||<br>Alloy|DURELON|Fuji Ionomer TYPE I|PANAVIA EX|<br>Au-Ag-Cu|−0.76|−0.87|−0.89|<br>Ag-Pd|−0.78|−0.83|−0.92|<br>Ag-Pd (hardened)|−0.78|−0.86|−0.86|<br>Ni-Cr|−0.78|−0.85|−0.90| <img> **Au-Ag-Cu** **Ag-Pd** **Ag-Pd (hardened)** **Ni-Cr** **Fig. 8 Effect of film thickness on tensile bond strength of adhesive resin cement to different dental alloys** _figures/img_de6bd6452e80dca5.webp) _figures/img_c53e9b017f59ddc6.webp) #### Correlation Between Film Thickness and Bond Strength Research indicates a strong negative correlation between film thickness and tensile bond strength across various dental alloys. **Correlation Coefficients (Film Thickness vs. Tensile Bond Strength)** | Alloy | DURELON | Fuji Ionomer TYPE I | PANAVIA EX | | :--- | :--- | :--- | :--- | | Au-Ag-Cu | -0.76 | -0.87 | -0.89 | | Ag-Pd | -0.78 | -0.83 | -0.92 | | Ag-Pd (hardened) | -0.78 | -0.86 | -0.86 | | Ni-Cr | -0.78 | -0.85 | -0.90 | Table 4 showing correlation coefficients between film thickness and tensile bond strength of dental luting cements. Columns include alloys (Au-Ag-Cu, Ag-Pd, Ag-Pd hardened, Ni-Cr) and cements (DURELON, Fuji Ionomer TYPE I, PANAVIA EX). Values range from -0.76 to -0.92. Fig. 8 bar chart illustrating the effect of film thickness on tensile bond strength of adhesive resin cement to different dental alloys. X-axis: Film thickness (µm); Y-axis: Tensile bond strength (MPa). Legend shows four alloy types: Au-Ag-Cu, Ag-Pd, Ag-Pd (hardened), Ni-Cr. Bond strength generally decreases as film thickness increases. **Elastic modulus and compressive strength** • If cement has a similar elastic modulus as dentin, there will be less stress concentration at the interface • Some studies claim that fracture of ceramic restoration begin at the cement layer. • Fracture load of zirconia crowns may not be greatly affected by cement type • However chemical adhesion may be more important for lithium disilicate crowns **Weak adhesion between ceramic and resin cement impairs the load-bearing capacity under fatigue of lithium disilicate glass-ceramic crowns** Lucas Saldanha da Rosa, Helder Callegaro Velho, João Paulo Mendes Tristão Luiz Felipe Valandro, Cornelis Johannes Kleverlaan, Gabriel Kalil Rocha Pereira **Conclusion** The chemical adhesion between cement and ceramic is essential for better fatigue behavior of lithium disilicate crowns with a simplified anatomy, especially in the occlusal portion, but the restoration performance is impaired when such adhesion is compromised. There is an increase in crown and cement stress concentration with the progressive loss of chemical bonding of the crown's walls. Fracture resistance of monolithic zirconia crowns: The importance of the compressive strength of the dental cements used. _figures/img_aa78982b3944c668.webp) _figures/img_29bfbd566b2f712d.webp) #### Stress Distribution and Material Compatibility - If a cement has a similar elastic modulus to dentin, there is less stress concentration at the interface. - Studies suggest that fractures in ceramic restorations may originate within the cement layer. #### Material-Specific Considerations - **Zirconia:** Fracture load of monolithic zirconia crowns may not be significantly affected by the type of cement used. - **Lithium Disilicate:** Chemical adhesion is essential for the fatigue behavior and load-bearing capacity of lithium disilicate glass-ceramic crowns. Weak adhesion increases stress concentration in the crown and cement, impairing performance. Bar chart titled 'Fracture load (N)' comparing Phosphate cement, RelyX, and Panavia. The Y-axis ranges from 0 to 6000 N. Bars show approximate values: Phosphate cement ~4200 N, RelyX ~3800 N, Panavia ~4800 N. Error bars indicate variability. Context relates to fracture resistance of monolithic zirconia crowns. Bar chart titled 'Compression strength (MPa)' comparing Phosphate cement, RelyX, and Panavia. The Y-axis ranges from 0 to 300 MPa. Bars show approximate values: Phosphate cement ~36.4 MPa, RelyX ~212.6 MPa, Panavia ~193.6 MPa. Error bars are present. Arrows point to each bar with annotations. Context relates to compressive strength of dental cements used in monolithic zirconia crowns. Compressive Strength **White and Yu** **Kerby et al** **Cattani-Lorente et al** **Miyamoto et al** **Zinc phosphate** **Polycarboxylate** **Glass ionomer** **Resin ionomer** **Resin** **Adhesive resin** ANSI/ADA Specification No. 96 COMPRESSIVE STRENGTH (MPa) FIGURE 30-4 Compressive strength of luting agents. In the studies cited, higher strength values were reported with the resin cements and glass ionomers than with zinc phosphate or polycarboxylate. Resin-modified glass ionomer exhibited greater variation than did other cements. ANSI/ADA, American Dental Association/American National Standards Institute. (From Rosenstiel SF, et al: Dental luting agents: a review of the current literature. J Prosthet Dent 80:280, 1998.) _figures/img_c627c491fb57ab09.webp) #### Comparative Compressive Strength According to ANSI/ADA Specification No. 96 and literature reviews (Rosenstiel et al.): 1. **Resin Cements:** Highest reported strength values. 2. **Glass Ionomers:** Higher strength than zinc phosphate or polycarboxylate. 3. **Resin-Modified Glass Ionomer (RMGI):** Exhibits greater variation in strength compared to other categories. 4. **Zinc Phosphate and Polycarboxylate:** Generally lower compressive strength values. Bar chart titled 'Compressive Strength' (Figure 30-4) displaying compressive strength in MPa for various dental luting agents: Zinc phosphate, Polycarboxylate, Glass ionomer, Resin ionomer, Resin, and Adhesive resin. Data is compared across four studies (White and Yu, Kerby et al, Cattani-Lorente et al, Miyamoto et al) using color-coded bars. A horizontal dashed line indicates the ANSI/ADA Specification No. 96 threshold. The caption notes that resin cements and glass ionomers exhibited higher strength values than zinc phosphate or polycarboxylate. Retention **Lithium disilicate crowns cemented adhesively with resin cement had a higher failure load compared to GIC. Additionally, fewer cases of debonding.** **Table 1. Mean failure loads (standard deviation) in N..** | Groups | Mean (sd) | |------------------|--------------------| | Composite group | 306.6 (193.8) | | GIC group | 94.7 (48.2) | ORIGINAL PUBLICATION DETAILS: **Effect of Different Luting Agents on the Retention of Lithium Disilicate Ceramic Crowns** Nicola Mobilio, Alberto Fasiol, Francesco Mollica and Santo Catapano _figures/img_34886c1e7e39dc92.webp) _figures/img_72456cfef2336cd1.webp) #### Failure Loads in Lithium Disilicate Crowns Lithium disilicate crowns cemented adhesively with resin cement demonstrate higher failure loads and fewer cases of debonding compared to Glass Ionomer Cement (GIC). **Mean Failure Loads (N)** | Groups | Mean (SD) | | :--- | :--- | | Composite group | 306.6 (193.8) | | GIC group | 94.7 (48.2) | Table 1 showing mean failure loads (standard deviation) in Newtons for two groups: Composite group with a mean of 306.6 and GIC group with a mean of 94.7. Bar chart comparing debondments and fractures between the Composite group and GIC group. The Composite group shows 10% debondments and 90% fractures, while the GIC group shows 60% debondments and 40% fractures. # Retention * Mixed literature regarding zirconia crowns * Some suggest MDP containing cements promoted better bond strength * Some found no differences * We will review zirconia bonding towards the end of this lecture ### Bond strength and stability of 3 luting systems on a zirconia-dentin complex Sebnem Begum Turker, DDS, PhD ▪ Mutlu Ozcan, PhD ▪ Gamze Mandali, DDS, PhD ▪ Isil Damla, DDS ▪ Burcu Bugurman, DDS Luiz Felipe Valandro, PhD <table> <caption>Table 2. Median and mean values (±SD) of shear bond strength (MPa) failure before and after aging procedure. Based on the results of Kruskal-Wallis and Mann-Whitney U-tests (α < .05).</caption> <thead> <tr> <th rowspan="2"></th> <th colspan="2">Immediate test</th> <th colspan="2">After aging</th> <th rowspan="2">Mann-Whitney U-tests</th> <th rowspan="2"><i>P</i> value</th> </tr> <tr> <th>Median (<i>P</i> = 0.0001; Kruskal-Wallis = 21.3)</th> <th>Mean (±SD)</th> <th>Median (<i>P</i> = 0.016; Kruskal-Wallis = 8.27)</th> <th>Mean (±SD)</th> </tr> </thead> <tbody> <tr> <td>GI</td> <td>2.93</td> <td>3.4 (1.23)</td> <td>4.02</td> <td>4.7 (3.4)</td> <td>44</td> <td>0.650</td> </tr> <tr> <td>RMGI</td> <td>8.37</td> <td>9.2 (3.80)</td> <td>4.66</td> <td>6.2 (3.7)</td> <td>24</td> <td>0.049</td> </tr> <tr> <td>MDP</td> <td>17.65</td> <td>16.9 (6.40)</td> <td>9.79</td> <td>11.3 (6.4)</td> <td>24</td> <td>0.049</td> </tr> </tbody> </table> Abbreviations: GI, glass ionomer; RMGI, resin-modified glass ionomer; MDP, resin cement containing 10-methacryloyloxydecyl dihydrogen phosphate. _figures/img_7bd2a0eea0a8b630.webp) #### Zirconia-Dentin Complex Bond Strength Literature regarding zirconia crowns is mixed; some studies suggest MDP-containing cements promote better bond strength, while others find no significant difference. **Shear Bond Strength (MPa) and Stability** | Cement Type | Immediate (Mean ± SD) | After Aging (Mean ± SD) | P value | | :--- | :--- | :--- | :--- | | GI (Glass Ionomer) | 3.4 (1.23) | 4.7 (3.4) | 0.650 | | RMGI | 9.2 (3.80) | 6.2 (3.7) | 0.049 | | MDP (Resin with MDP) | 16.9 (6.40) | 11.3 (6.4) | 0.049 | Table 2 showing median and mean values (±SD) of shear bond strength (MPa) failure before and after aging procedure for three luting systems: GI, RMGI, and MDP. The table includes columns for Immediate test (Median and Mean), After aging (Median and Mean), Mann-Whitney U-tests, and P value. Key highlighted values in red circles are the immediate test means for GI (3.4), RMGI (9.2), and MDP (16.9). Abbreviations at the bottom define GI as glass ionomer, RMGI as resin-modified glass ionomer, and MDP as resin cement containing 10-methacryloyloxydecyl dihydrogen phosphate. Retention **FIGURE 30-3** **Crown retention studies: effect of luting agent.** In the six *in vitro* studies cited, researchers evaluated the effect of luting agent on crown retention. The data were normalized as percentages of the retention value with zinc phosphate cement. Adhesive resins had consistently greater retention than did zinc phosphate. Conventional resins and glass ionomers yielded less consistent results. (From Rosenstiel SF, et al: Dental luting agents: a review of the current literature. J Prosthet Dent 80:280, 1998.) _figures/img_d44fc9392170e167.webp) #### Comparative Crown Retention In vitro studies evaluating the effect of luting agents on crown retention (normalized against zinc phosphate) show: - **Adhesive Resins:** Consistently higher retention than zinc phosphate. - **Conventional Resins and Glass Ionomers:** Yielded less consistent results across different studies. Bar chart titled 'FIGURE 30-3 Crown retention studies: effect of luting agent.' The vertical axis is labeled 'Percent retention of zinc phosphate' ranging from 0 to 300. A dashed horizontal line marks the 100% baseline representing Zinc phosphate. The horizontal axis categorizes four types of luting agents: Glass ionomer, Resin, Adhesive resin, and Polycarboxylate. Multiple colored bars represent data from different in vitro studies (Ayad et al, Gorodovsky and Zidan, Wiskott et al, Tjan and Li, Mojon et al, Mausner et al). Hand-drawn annotations include a circle around 'Resin', a circle around 'Adhesive resin', and an arrow pointing to the 'Zinc phosphate' label. **Zinc Oxide Eugenol** * **Basic composition:** * Zinc oxide + Eugenol + Rosin + Zinc Acetate * **Low strength + high solubility in oral environment** * **A potential “sedative” effect for the pulp and otherwise biocompatible** * **Issues with eugenol inhibiting resin polymerization** * **Temporary cement** _figures/img_5eb017aca4fa7b7c.webp) #### Composition and Properties - **Basic composition:** Zinc oxide + Eugenol + Rosin + Zinc Acetate - **Strength:** Low strength and high solubility in the oral environment. - **Biocompatibility:** Provides a potential “sedative” effect for the pulp and is otherwise biocompatible. #### Clinical Considerations - **Resin Inhibition:** Eugenol can inhibit resin polymerization. - **Primary Use:** Indicated as a temporary cement. University logo for The University of Western Australia, featuring a shield with a swan and Latin motto 'Utter Minus', alongside the university name in blue text. Serves as an institutional identifier. #Zinc Phosphate **THE UNIVERSITY of WESTERN AUSTRALIA** * **Basic composition:** * Zinc oxide + magnesium oxide + phosphoric acid + water +buffers * Popular cement for use in traditional cast restorations, (has been around since 1800s) * Acceptable film thickness of 25um * Ease of removal of the excess material after setting * Potential issues with biocompatibility due to the inclusion of phosphoric acid (pH 2 at time of cementing). However generally well tolerated if preparation is not too close to the pulp * Acceptable working time of about 5 minutes _figures/img_d463dc9ff5197132.webp) _figures/img_61a477fe0d10b6e9.webp) #### Composition and History - **Basic composition:** Zinc oxide + magnesium oxide + phosphoric acid + water + buffers - **Background:** Popular cement for use in traditional cast restorations; has been in use since the 1800s. #### Clinical Performance - **Film Thickness:** Acceptable film thickness of 25μm. - **Handling:** Ease of removal of excess material after setting. - **Working Time:** Acceptable working time of approximately 5 minutes. #### Biocompatibility - Potential issues due to the inclusion of phosphoric acid (pH 2 at the time of cementing). - Generally well tolerated if the preparation is not too close to the pulp. Photo of a dental product packaging and components for Zinc Phosphate Cement. The image shows a white box labeled 'Zinc Phosphate Cement', two small bottles with dropper caps (one labeled 'ZINC PHOSPHATE CEMENT' and the other '17.5ml Liquid'), and text indicating it is from 'Dentsply'. This visual corresponds to the textual information about the cement's composition and use. Photo of an alternative brand of Zinc Phosphate Cement. The image displays a purple box labeled 'Cem-Zinc Zinc Phosphate Cement' along with two small bottles (one labeled 'Cem-Zinc' and another partially visible). This visual supports the discussion on popular cements used in traditional cast restorations mentioned in the OCR text. **Zinc Polycarboxylate** **Basic composition** Zinc oxide + polyacrylic acid Attempts to address some biocompatibility issues from zinc phosphate by changing to polyacrylic acid Also exhibits some adhesion to the tooth surface through chelation of calcium (but not to cast metal surfaces) Potentially technique sensitive due to mixing of viscosus powder and liquid (mitigated via capsules) Additionally very short working time of under 3 minutes Indicated for high retention preps, or close to pulp horns Poly Zinc<sup>+</sup> Zinc Polycarboxylate Cement Poly Zinc<sup>+</sup> Zinc Polycarboxylate Cement imibond-p imibond-p imibond-p _figures/img_551875031da5fcf4.webp) _figures/img_96314cf91051bd0e.webp) #### Composition and Adhesion - **Basic composition:** Zinc oxide + polyacrylic acid - **Development:** Attempts to address biocompatibility issues of zinc phosphate by utilizing polyacrylic acid. - **Adhesion:** Exhibits some adhesion to the tooth surface through chelation of calcium (note: does not adhere to cast metal surfaces). #### Handling and Indications - **Technique Sensitivity:** Potentially sensitive due to the mixing of viscous powder and liquid (mitigated via capsules). - **Working Time:** Very short working time of under 3 minutes. - **Indications:** Recommended for high retention preparations or preparations close to pulp horns. Product packaging and vials for 'Poly Zinc+' Zinc Polycarboxylate Cement. Shows a green box with product branding and two small bottles (one amber glass, one white plastic) containing the cement components. Product packaging and vials for 'imibond-p' Zinc Polycarboxylate Cement. Shows a white box with blue branding and two small bottles (one amber glass, one white plastic) alongside a blue mixing spatula on a surface. Glass ionomer cement (GIC) • Basic composition - Polycarboxylate + fluorialuminosilicate glass + water + tartaric acid • Good biocompatibility + theoretically anticariogenic • Aesthetic due to translucency of the cement • Potential for water absorption during early setting which would lead to erosion of the weakened material • Ionic bonding to tooth structure • Concerns regarding possible post-op sensitivity not supported by literature when manufacturer guidelines followed _figures/img_3d4d1080ec5f6ba7.webp) #### Composition and Bonding - **Basic composition:** Polycarboxylate + fluorialuminosilicate glass + water + tartaric acid - **Bonding:** Ionic bonding to tooth structure. #### Clinical Advantages - **Biocompatibility:** Good biocompatibility and theoretically anticariogenic. - **Aesthetics:** Translucent properties provide good aesthetic results. #### Considerations - **Moisture Sensitivity:** Potential for water absorption during early setting, which can lead to erosion of the weakened material. - **Post-operative Sensitivity:** Concerns regarding sensitivity are not supported by literature when manufacturer guidelines are followed. Product photograph of Glass Ionomer Cement (GIC) materials including GC FujiCEM paste bottles, mixing pad, and spatula. # Resin modified glass ionomer THE UNIVERSITY OF WESTERN AUSTRALIA * Basic composition * GIC + resin * Due to the inclusion of resin and corresponding photoactivators, some of the issues of GIC cement were improved * Resin matrix improves the mechanical properties such as compressive and fracture strength compared to unmodified GIC * Also suggest improvement in retention and bond strength * Could be harder to remove excess. (Remember to tack cure) * Some studies say it is contraindicated for all ceramic crowns (risk of fracture after water absorption) * Latest generation of resin-modified glass ionomer cement * Excellent handling, consistency and bond strength * Easy clean-up and one-step application, saving chair time * Ideal for cementation of zirconia, PFM and lithium disilicate restorations * High fluoride release * Moisture tolerant, no isolation required _figures/img_b6579cf1dba91ed2.webp) #### Composition and Improvements - **Basic composition:** GIC + resin - **Enhancements:** Inclusion of resin and photoactivators improves upon standard GIC issues. - **Mechanical Properties:** Resin matrix improves compressive and fracture strength; suggests improved retention and bond strength. #### Clinical Handling - **Cleanup:** Can be harder to remove excess; tack curing is recommended. - **Latest Generation Features:** - Excellent handling, consistency, and bond strength. - Easy clean-up and one-step application. - Moisture tolerant; no isolation required. - High fluoride release. #### Indications and Contraindications - **Indications:** Ideal for cementation of zirconia, PFM, and lithium disilicate restorations. - **Contraindications:** Some studies suggest it is contraindicated for all-ceramic crowns due to the risk of fracture after water absorption. Product packaging image of GC FujiCEM-2 resin-modified glass ionomer cement. The box is pink with white and blue text detailing product information. Accompanying the box are a syringe applicator filled with the cement material, a small bottle of liquid (likely activator or water), and several pre-measured capsules containing the powder component. This visual demonstrates the complete kit components for clinical use. RESIN BASED CEMENTS **BASIC COMPOSITION** Resin + filler (lower filler ratio for lower film thickness) **SIMILAR TO RESTORATIVE COMPOSITE (EXACTLY THE SAME STEPS REQUIRED)** *Offers micromechanical retention* *Very high compressive strength* *Least soluble* *Technique sensitive (moisture control)* *May be more expensive* *Self cure, dual cure or light cure options* Removal of excess may be difficult if not removed at tack cure stage Variolink Esthetic DC Refill Variolidin Esthetic DC _figures/img_c5feba3e87c5b460.webp) #### Composition and Characteristics - **Basic composition:** Resin + filler (lower filler ratio utilized for lower film thickness). - **Retention:** Offers micromechanical retention. - **Physical Properties:** Very high compressive strength and the least soluble of the cement types. #### Clinical Application - **Procedure:** Similar to restorative composite; requires the exact same steps. - **Curing Options:** Available in self-cure, dual-cure, or light-cure options. - **Technique Sensitivity:** Highly sensitive to moisture control. - **Cleanup:** Removal of excess may be difficult if not performed at the tack cure stage. - **Cost:** May be more expensive than other options. Product photograph of an 'Ivoclar Vivadent' dental material. The image shows a white box labeled 'Variolink Esthetic DC Refill', accompanied by several syringes and mixing tips used for dispensing the cement. # Special mention: Panavia ## Panavia * Resin cement with bifunctional monomer, 10-methacryloyloxydecyldihydrogen-phosphate (MDP) * 10-MDP is able to interact with metal oxides via the hydrophilic phosphoric acid end group * 10-MDP also facilitate a chemical bond with dentin through the formation of MDP-Ca insoluble salts ## Structure of Adhesive Monomer MDP | Part | Group | | :--- | :--- | | **Polymerisable group** | Polymeristieable group | | **Hydrophobic group** | CH2 CH2 CH2 CH2 CH2 CH2 CH2 CH2 CH2 CH2 | | **Hydrophilic group** | CH3-C=C-CO-O-P-OH OH *Hand drawn circles indicating Polymerisable, Hydrophobic, and Hydrophilic groups.* _figures/img_e27b5523b2b212fb.webp) _figures/img_a9a83179aaa25ad6.webp) #### Panavia and 10-MDP Panavia is a resin cement featuring the bifunctional monomer 10-methacryloyloxydecyldihydrogen-phosphate (MDP). - **Metal Bonding:** 10-MDP interacts with metal oxides via the hydrophilic phosphoric acid end group. - **Dentin Bonding:** 10-MDP facilitates a chemical bond with dentin through the formation of MDP-Ca insoluble salts. #### Structure of Adhesive Monomer MDP | Part | Group | | :--- | :--- | | **Polymerisable group** | Polymerisable group | | **Hydrophobic group** | Aliphatic chain (CH2)10 | | **Hydrophilic group** | Phosphate group (P-OH) | Labelled diagram of the structure of adhesive monomer MDP. The diagram shows a chemical formula with three distinct parts labeled at the bottom: 'Polymerisable group' pointing to the methacrylate double bond on the left; 'Hydrophobic group' pointing to the long hydrocarbon chain in the center; and 'Hydrophilic group' pointing to the phosphoric acid end on the right. Red hand-drawn circles highlight each of these three specific regions. Photograph showing the Panavia F2.0 dental cement product packaging (box) and the contents of the kit inside an open blue metal case. | TABLE 30-2 Indications for and Contraindications to Luting Agent Types | | | | :--- | :--- | :--- | | **Restoration** | **Indication** | **Contraindication** | | Cast crown, metal-ceramic crown, partial FDP | 1, 2, 3, 4, 5, 6, 7 | — | | Crown or partial FDP with poor retention | 1, 2 | 3, 4, 5, 6, 7 | | MCC with porcelain margin | 1, 2, 3, 4, 5, 6, 7 | — | | Casting on patient with history of post-treatment sensitivity | Consider 4 or 7 | 2 | | Pressed, high-leucite, ceramic crown | 1, 2 | 3, 4, 5, 6, 7 | | Slip-cast alumina crown | 1, 2, 3, 4, 6, 7 | 5 | | Ceramic inlay | 1, 2 | 3, 4, 5, 6, 7 | | Ceramic veneer | 1, 2 | 3, 4, 5, 6, 7 | | Resin-retained partial FDP | 1, 2 | 3, 4, 5, 6, 7 | | Cast post-and-core | 1, 2, 3, 5, 6 | 4, 7 | | **Key** | | | | **LUTING AGENT TYPE** | **CHIEF ADVANTAGES** | **CHIEF CONCERNS** | **PRECAUTIONS** | | 1. Adhesive resin | Adhesive, low solubility | Film thickness, history of use | Moisture control | | 2. Self-etch adhesive resin | Low solubility, ease of use, bonding to dentin | Film thickness | Moisture control | | 3. Glass ionomer | Translucency | Solubility, leakage | Avoid early moisture exposure | | 4. Reinforced ZOE | Biocompatible | Low strength | Only for very retentive restorations | | 5. Resin ionomer | Low solubility, low microleakage | Water sorption, history of use | Avoid with ceramic restorations | | 6. Zinc phosphate | History of use | Solubility, leakage | Use for “traditional” cast restorations | | 7. Zinc polycarboxylate | Biocompatible | Low strength, solubility | Do not reduce powder-to-liquid ratio | *FDP, Fixed dental prosthesis; MCC, metal-ceramic crown; ZOE, zinc oxide–eugenol. _figures/img_5266c45b1291a598.webp) #### Clinical Indications Table | Restoration | Indication | Contraindication | | :--- | :--- | :--- | | Cast crown, metal-ceramic crown, partial FDP | 1, 2, 3, 4, 5, 6, 7 | — | | Crown or partial FDP with poor retention | 1, 2 | 3, 4, 5, 6, 7 | | MCC with porcelain margin | 1, 2, 3, 4, 5, 6, 7 | — | | Casting on patient with history of sensitivity | Consider 4 or 7 | 2 | | Pressed, high-leucite, ceramic crown | 1, 2 | 3, 4, 5, 6, 7 | | Slip-cast alumina crown | 1, 2, 3, 4, 6, 7 | 5 | | Ceramic inlay | 1, 2 | 3, 4, 5, 6, 7 | | Ceramic veneer | 1, 2 | 3, 4, 5, 6, 7 | | Resin-retained partial FDP | 1, 2 | 3, 4, 5, 6, 7 | | Cast post-and-core | 1, 2, 3, 5, 6 | 4, 7 | #### Luting Agent Key 1. **Adhesive resin**: Adhesive, low solubility. (Precaution: Moisture control) 2. **Self-etch adhesive resin**: Low solubility, ease of use, bonding to dentin. (Precaution: Moisture control) 3. **Glass ionomer**: Translucency. (Precaution: Avoid early moisture exposure) 4. **Reinforced ZOE**: Biocompatible. (Concern: Low strength; Use only for very retentive restorations) 5. **Resin ionomer**: Low solubility, low microleakage. (Precaution: Avoid with ceramic restorations) 6. **Zinc phosphate**: History of use. (Concern: Solubility, leakage) 7. **Zinc polycarboxylate**: Biocompatible. (Concern: Low strength, solubility; Do not reduce powder-to-liquid ratio) *Abbreviations: FDP (Fixed dental prosthesis); MCC (Metal-ceramic crown); ZOE (Zinc oxide–eugenol).* Table 30-2: Indications for and Contraindications to Luting Agent Types. The table is divided into two main sections. The upper section lists various dental restorations (e.g., Cast crown, Ceramic veneer) and maps them to specific luting agent types (numbered 1-7) in the 'Indication' column or lists contraindications in the 'Contraindication' column. The lower section provides a 'Key' defining each of the 7 luting agent types (Adhesive resin, Glass ionomer, Zinc phosphate, etc.) with their Chief Advantages, Chief Concerns, and Precautions. # Cementation * After ensuring permanent crown seats fully (covered in other lecture, and consent from patient to cement. * Zirconia vs Lithium Disilicate crowns #### Pre-Cementation Requirements - Ensure the permanent crown seats fully. - Obtain patient consent for cementation. - Determine material type: Zirconia vs. Lithium Disilicate crowns. Glassy ceramic crowns **Lithium disilicate, etc.** • **Lab steps:** • Prior to returning the crown, the lab may have already etched the internal fitting surface with hydrofluoric acid (eg ceram etch 9% hydrofluoric gel) <sup>SiO</sup><sub>2</sub><sub>(</sub><sub>s</sub><sup>)) + 4</sup> **HF**<sub>(</sub><sub>aq</sub><sup>) → SiF</sup><sub>4</sub><sub>(</sub><sub>g</sub><sup>) + 2</sup> **H</sup><sub>2</sub>O(l)) <sup>4 SiF</sup><sub>4</sub><sub>(</sub><sub>g</sub><sup>) + 3</sup> **H</sup><sub>2</sub>O(l) + 2</sup> **HF**<sub>(</sub><sub>aq</sub><sup>) → 3</sup> **H</sup><sub>2</sub>SiF<sub>6</sub><sub>(</sub><sub>aq</sub><sup>) + H</sup><sub>2</sub>SiO<sub>3</sub>(aq)) (2) (3) A 15 kV x2,000 10 µm 1% 20 s **1% HF 20 s** D 15 kV x 2 808 10 % 128 s **1% HF 120 s** - - _figures/img_f21d459bb8fb6326.webp) _figures/img_cdc28404690d7004.webp) #### Hydrofluoric Acid Etching Prior to returning the crown, the laboratory may have already etched the internal fitting surface with hydrofluoric acid (e.g., Ceram Etch 9% hydrofluoric gel). **Chemical Reactions:** - SiO₂(s) + 4 HF(aq) → SiF₄(g) + 2 H₂O(l) - 4 SiF₄(g) + 3 H₂O(l) + 2 HF(aq) → 3 H₂SiF₆(aq) + H₂SiO₃(aq) **Etching Time Comparisons:** - 1% HF for 20 seconds (10 µm surface change at x2,000 magnification). - 1% HF for 120 seconds (Significant surface change at x2,808 magnification). Scanning Electron Micrograph (SEM) labeled 'A' showing a smooth surface texture of glassy ceramic. Image parameters include 15kV, x2,000 magnification, and a 10um scale bar. A red arrow points to the relatively uniform surface. The caption below reads '1% HF 20 s', indicating etching conditions. Scanning Electron Micrograph (SEM) labeled 'D' showing a rough surface with distinct needle-like or rod-shaped structures. Image parameters include 15kV, x2,000 magnification, and a 10um scale bar. A red arrow points towards the crystalline structures. The caption below reads '1% HF 120 s', indicating longer etching duration compared to image A. # Glassy ceramic crowns **Lithium disilicate, etc.** - **Lab steps:** - Prior to returning the crown, the lab may have already etched the internal fitting surface with hydrofluoric acid (eg ceram etch 9% hydrofluoric gel) - Silane coupling agent eg 3-methacryloxypropyltri-methoxysilane (MPS) forms bridge between the organic compounds in resin cements and inorganic ceramic molecules, hence improving the bond strength. Also increase surface energy and contact angle decreased for better resin/adhesive contact. **Influence of the Multiple Layers Application and the Heating of Silane on the Bond Strength between Lithium Disilicate Ceramics and Resinous Cement** Uriel Paulo Coelho Silva¹, Andréea Peixoto Maia², Isaias Donizeti Silva³, Milton Edson Miranda², William Cunha Brandt³,* _figures/img_b4c5c12a405b6863.webp) #### Laboratory Surface Conditioning - **Hydrofluoric Acid Etching:** The lab may etch the internal fitting surface with hydrofluoric acid (e.g., 9% HF gel) before delivery. - **Silane Coupling Agent:** Application of agents such as 3-methacryloxypropyltrimethoxysilane (MPS). - Forms a bridge between organic compounds in resin cements and inorganic ceramic molecules. - Improves bond strength. - Increases surface energy and decreases contact angle for better resin/adhesive contact. #### Research Reference *Influence of the Multiple Layers Application and the Heating of Silane on the Bond Strength between Lithium Disilicate Ceramics and Resinous Cement* — Silva et al. Chemical structure diagram illustrating the interaction between Silane (MTPS) and a Silica surface. The left panel shows hydrogen bonding interactions between the silane molecule and the silica surface. The right panel demonstrates the formation of a covalent bond between the silane and the silica surface after heating, as indicated by the curved arrow showing water removal. Glassy ceramic crowns Lithium disilicate, etc. * Lab steps: * Prior to returning the crown, the lab may have already etched the internal fitting surface with hydrofluoric acid (eg ceram etch 9% hydrofluoric gel) * Silane coupling agent eg 3-methacryloxypropyltri-methoxysilane (MPS) forms bridge between the organic compounds in resin cements and inorganic ceramic molecules, hence improving the bond strength. Also increase surface energy and contact angle decreased for better resin/adhesive contact. Influence of the Multiple Layers Application and the Heating of Silane on the Bond Strength between Lithium Disilicate Ceramics and Resinous Cement Uriel Paulo Coelho Silva$^{1}$ AndrEA Peixoto Maia$^{2}$ Isaías Donizeti Silva $^{3}$ Milton Edson Miranda$^{2}$ William Cunha Brandt$^{3}.$* _figures/img_5e1db55cfbdb1f82.webp) _figures/img_0e0ed59876be69b6.webp) #### Laboratory Preparation Steps - **Etching:** Internal fitting surface etching with hydrofluoric acid (e.g., 9% HF gel). - **Silanization:** Use of 3-methacryloxypropyltrimethoxysilane (MPS) to create a chemical bridge between the resin cement and the ceramic, enhancing bond strength and surface wettability. #### Research Reference *Influence of the Multiple Layers Application and the Heating of Silane on the Bond Strength between Lithium Disilicate Ceramics and Resinous Cement* — Silva, Maia, Silva, Miranda, and Brandt. Chemical structure diagram illustrating the interaction between Silane (MTPS) and a Silica surface. It shows molecular bonding with dashed lines representing hydrogen bonds or weak interactions. Chemical structure diagram showing the effect of silane coupling agent on bond strength. Includes red annotations highlighting 'covalent bond' formation, increased surface energy, and improved contact angle for better resin/adhesive contact. Arrows indicate directionality of interaction. **Zirconia crowns** **Zirconia:** **Lab steps:** * Not able to be etched * Micromechanical surface treatments * Airborne particle abrasion to increase surface roughness (Pressure ~1 bar) * Chemical surface treatments * Hot acid treatment (eg sulfuric acid and hydrogen peroxide) * Silica coating (aluminum oxide particle coated with silica) Effects of airborne-particle abrasion protocol choice on the surface characteristics of monolithic zirconia materials and the shear bond strength of resin cement Ji-Eun Moon **a**, Sung-Hun Kim **a**, Jai-Bong Lee **a**, Jung-Suk Han **a**, In-Sung Yeo **a**, Seung-Ryong Ha **b** _figures/img_7412ecdbd2d97f89.webp) #### Laboratory Surface Treatments Zirconia cannot be etched with traditional acids. Preparation requires: - **Micromechanical Treatments:** - Airborne particle abrasion (sandblasting) to increase surface roughness (Pressure ~1 bar). - **Chemical Treatments:** - Hot acid treatment (e.g., sulfuric acid and hydrogen peroxide). - Silica coating (aluminum oxide particles coated with silica). #### Research Reference *Effects of airborne-particle abrasion protocol choice on the surface characteristics of monolithic zirconia materials and the shear bond strength of resin cement* — Moon et al. Scanning Electron Microscope (SEM) micrographs comparing surface topography of zirconia under different treatments. Top panel labeled 'Control' shows a relatively smooth surface with faint linear scratches. Middle and bottom panels labeled 'Air-abraded' show significantly rougher surfaces with irregular textures resulting from airborne-particle abrasion. # **Glassy ceramics** • After try in completed • **Fitting surface cleanser: Katana** or **Ivoclean** • Otherwise can use phosphoric acid to remove saliva contaminants _figures/img_6027265bd690b51b.webp) _figures/img_b52cdf2b493c3dbc.webp) #### Post-Try-In Cleaning Once the try-in procedure is completed, the fitting surface must be cleaned: - **Specialized Cleansers:** Use Katana Cleaner or Ivoclean. - **Alternative:** Phosphoric acid can be used to remove saliva contaminants from the glassy ceramic surface. Product photo of Katana Cleaner bottle (purple cap and black body), referenced in the text as a fitting surface cleanser for glassy ceramics. Product photo of Ivoclean paste bottle with dropper cap, referenced in the text as an alternative fitting surface cleanser for glassy ceramics. #### Clinical Cleaning and Application (Page contains no unique text beyond the header context provided in the assignment; content is identical to the cleaning protocols for glassy ceramics.) # What about zirconia? **Cleaning Zirconia Surface Prior To Bonding: A Comparative Study of Different Methods and Solutions** Taiseer A. Sulaiman, DDS, PhD<sup>1</sup> Ali Altak, DDS,<sup>1</sup> Awab Abdulmajeed, DDS, MS<sup>2</sup> Brandon Rodgers, BS,<sup>1</sup> & Nathaniel Lawson, DMD, PhD<sup>3</sup> <sup>1</sup>Division of Comprehensive Oral Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina <sup>2</sup>Department of General Practice, School of Dentistry, Virginia Commonwealth University, Richmond, Virginia <sup>3</sup>Division of Biomaterials, University of Alabama School of Dentistry, Birmingham, Alabama --- **Conclusion:** Air-borne particle, zirconia cleaning solutions and hydrofluoric acid are feasible to decontaminate the zirconia surface from saliva prior to bonding the restoration. Air-borne particle abrasion: best outcome to restore previous uncontaminated surface bond strengths. Followed by HF acid or intaglio cleaners #### Zirconia Surface Decontamination *Cleaning Zirconia Surface Prior To Bonding: A Comparative Study of Different Methods and Solutions* — Sulaiman et al. **Study Conclusions:** - Airborne particle abrasion, zirconia cleaning solutions, and hydrofluoric acid are all feasible for removing saliva contamination. - **Airborne particle abrasion** provided the best outcome for restoring bond strengths to uncontaminated levels. - This is followed in effectiveness by HF acid or specialized intaglio cleaners. # Glassy ceramics ## Variolink® Esthetic LC ### Eingliederung von Inlays (Stärke < 2 mm) (Glaskeramik, z. B. IPS e.max®) **Einprobe** 1. Auftragen der Try-In Paste 2. Einprobe der Restauration 3. Reinigung nach der Einprobe 4. Trockenlegung **Restauration** 1. $H_2O$ (Spülen) 2. LUFT! (Trocknen) 3. Monobond Etch & Prime (20 s einwirken, 40 s reagieren) 4. $H_2O$ (Spülen) 5. LUFT! (Trocknen) **Präparation** 1. $H_2O$ (Reinigen) 2. LUFT! (Trocknen) 3. Total Etch (optional, 15-30 s Schmelz, 15 s Dentin) 4. $H_2O$ (Spülen) 5. LUFT! (Trocknen) 6. Adhese Universal (20 s einreiben) 7. LUFT! (Verblasen bis zum dünnen Film) 8. Bluephase Style (10 s Lichtpolymerisation) **Befestigung** 1. Variolink Esthetic LC auftragen 2. Einsetzen der Restauration 3. Bluephase Style (2 s Fixieren der Ränder) 4. Überschussentfernung 5. Liquid Strip (Glycerin-Gel auftragen) 6. Abschließende Lichtpolymerisation (10 s pro Segment) 7. Polieren 8. Fluor Protector (Fluoridierung) #### Variolink Esthetic LC Protocol (Inlays < 2mm) **1. Try-In Phase** - Apply Try-In paste. - Seat restoration for evaluation. - Clean restoration after try-in. - Ensure isolation/dryness. **2. Restoration Preparation** - Rinse with water and air dry. - Apply Monobond Etch & Prime (20s scrub, 40s reaction time). - Rinse with water and air dry. **3. Tooth Preparation** - Clean with water and air dry. - Optional: Total Etch (15-30s enamel, 15s dentin). - Rinse and air dry. - Apply Adhese Universal (20s scrub). - Air thin to a film and light cure (10s). **4. Cementation and Finishing** - Apply Variolink Esthetic LC and seat restoration. - Tack cure margins (2s). - Remove excess cement. - Apply Liquid Strip (glycerin gel). - Final light cure (10s per segment). - Polish and apply Fluor Protector. A detailed multi-step clinical procedure diagram for the "Variolink Esthetic LC" glassy ceramic inlay. The diagram is divided into three main sections: 'Einprobe' (Try-in), 'Restauration' (Restoration), and 'Präparation' (Preparation). Each section contains numbered steps with illustrations showing specific dental actions (e.g., applying paste, drying, etching) and associated text instructions including chemical names like Monobond Etch & Prime and Adhese Universal, along with timing details (e.g., 20s, 40s). A vertical step-by-step procedure diagram titled 'Befestigung' (Fixation/Placement). It illustrates the process of cementing the restoration using Variolink Esthetic LC, Bluephase Style light curing, Liquid Strip, and Fluor Protector. The visual includes icons for tools and teeth diagrams showing the progression from applying cement to final polishing. #### Clinical Cleaning and Application (Page contains no unique text beyond the header context provided in the assignment; content is identical to the cleaning protocols for glassy ceramics.) # Zirconia ## **Dual Cure™ Dental Adhesive System PANAVIA F 2.0** ### Cementation of ceramic oxide restorations: PROCERA™, IN-CERAM™, CERCON™ and other zirconia prostheses. | **Step** | **Image** | **Instructions** | | :--- | :--- | :--- | | **1** | | Mix equal amounts of ED PRIMER II A&B and apply to the tooth. Then, wait 30 sec.<br>*ED PRIMER II initiates set of cement. | | **2** | | Gently air dry. | | **3** | | Dispence equal amounts of paste A&B. | | **4** | | Mix paste A&B for 20 sec. | | **5** | | Apply the mixture of the paste to the sandblasted crown. | #### Panavia F 2.0 Protocol for Zirconia 1. **Tooth Priming:** Mix equal amounts of ED PRIMER II A & B. Apply to the tooth and wait 30 seconds. (Note: This primer initiates the cement set). 2. **Drying:** Gently air dry the tooth surface. 3. **Dispensing:** Dispense equal amounts of Paste A & B. 4. **Mixing:** Mix Paste A & B for 20 seconds. 5. **Application:** Apply the mixed paste to the internal surface of the sandblasted zirconia crown. A step-by-step procedure diagram for the cementation of zirconia restorations using PANAVIA F 2.0. The image is divided into panels labeled 1, 2, and 3. Panel 1 shows applying ED PRIMER II to a tooth with a '30 s' timer overlay; text below instructs to mix and apply A&B paste then wait 30 seconds. Panel 2 shows air drying with an H₂O icon. Panel 3 displays two syringes (A & B) being dispensed side-by-side with a reference line. Green arrows point to specific areas in the image. A continuation of the dental procedure diagram containing panels 4 and 5. Panel 4 illustrates mixing paste A&B on a blue surface with a spatula for 20 seconds. Panel 5 shows applying the mixed paste onto a sandblasted crown. Green arrows indicate the flow of action within these steps. **Zirconia** **THE UNIVERSITY OF WESTERN AUSTRALIA** **3** Cementation of ceramic oxide restorations: PROCERA™, IN-CERAM™, CERCON™ and other zirconia prostheses. **PANAVIA F 2.0** 6 Remove excess cement. (For easy clean up, partially light-cure the excess cement for 2-3 sec. with conventional halogen or LED light, then remove the excess.) **7-a** Conventional halogen, LED 20 s Plasma arc, fast halogen 5 s Light cure the margins. 20sec. per surface (Conventional halogen or LED light) 5sec. per surface (Plasma arc or fast halogen light) **OR** **7-b** **3 min** Self cure material by applying OXYGUARD II to the margins. Then, wait 3 min. #### Panavia F 2.0 Finishing Procedures **6. Excess Removal:** - Remove excess cement. - For easier cleanup, tack-cure excess for 2-3 seconds before removal. **7. Final Polymerization (Choose A or B):** - **Option A (Light Cure):** Cure margins for 20 seconds per surface (Conventional/LED) or 5 seconds per surface (Plasma arc/Fast halogen). - **Option B (Self Cure):** Apply OXYGUARD II to the margins and wait 3 minutes to ensure anaerobic cure. Diagram labeled '6' showing the removal of excess dental cement from a tooth restoration. The image depicts a hand using an instrument to scrape away white cement material from the margins of a ceramic crown. A green arrow points to the area being cleaned. Text below reads: 'Remove excess cement. (For easy clean up, partially light-cure the excess cement for 2-3 sec. with conventional halogen or LED light, then remove the excess.)' Diagram labeled '7-a' illustrating the light curing of zirconia prosthesis margins. It shows a dental model with teeth and a black light source positioned at the gum line. An orange box indicates timing: 'Conventional halogen, LED 20 s' and 'Plasma arc, fast halogen 5 s'. Text explains: 'Light cure the margins. 20sec. per surface (Conventional halogen or LED light) 5sec. per surface (Plasma arc or fast halogen light)'. Green arrows point from this diagram towards the next step. Diagram labeled '7-b' showing an alternative method for self-curing material application. It displays a dental model with a syringe applying a substance along the margin of a tooth restoration. A green dashed line highlights the treated area. An orange box specifies '3 min'. Text below reads: 'Self cure material by applying OXYGUARD II to the margins. Then, wait 3 min.' A green underline is drawn under 'wait 3 min.' in the text. # Metal crowns/PFM crowns ## PANAVIA F 2.0 **Cementation of precious & semi-precious metal crowns, PFM crowns, bridges, inlays and onlays.** ```mermaid graph TD Step1[1. Sandblast, wash & dry.] --> Step2[2. Apply ALLOY PRIMER to internal surface of precious metal restoration.] Step2 --> Step3[3. Mix equal amounts of ED PRIMER II A&B. Apply to the tooth. Then, wait 30 sec. <br> *ED PRIMER II initiates set of cement.] Step3 --> Step4[4. Gently air dry.] Step4 --> Step5[5. Dispense equal amounts of paste A&B.] Step5 --> Step6[6. Mix paste A&B for 20 sec.] ``` #### Panavia F 2.0 Protocol for Metal Restorations 1. **Surface Prep:** Sandblast the internal surface, wash, and dry. 2. **Metal Priming:** Apply ALLOY PRIMER to the internal surface of precious metal restorations. 3. **Tooth Priming:** Mix ED PRIMER II A & B, apply to tooth, and wait 30 seconds. 4. **Drying:** Gently air dry the tooth. 5. **Dispensing:** Dispense equal amounts of Paste A & B. 6. **Mixing:** Mix Paste A & B for 20 seconds. A labelled diagram showing the first three steps of a dental procedure for cementing metal crowns. Step 1 shows sandblasting and drying a crown. Step 2 shows applying an ALLOY PRIMER to the internal surface. Step 3 shows mixing ED PRIMER II A&B on the tooth and waiting 30 seconds. A labelled diagram showing the next three steps of the same dental procedure. Step 4 shows gently air drying the tooth. Step 5 shows dispensing equal amounts of PANAVIA F 2.0 paste A&B using syringes with a reference line. Step 6 shows mixing the paste for 20 seconds. # Metal crowns/PFM crowns THE UNIVERSITY OF WESTERN AUSTRALIA 1 Cementation of precious & semi-precious metal crowns, PFM crowns, bridges, inlays and onlays. **DUAL CURE DENTAL ADHESIVE SYSTEM** **PANAVIA F2.0** Cementation of precious & semi-precious metal crowns, PFM crowns, bridges, inlays and onlays. 9-a Conventional halogen, LED 20 s Plasma arc, fast halogen 5 s Light cure the margins. 20sec. per surface (Conventional halogen or LED light) 5sec. per surface (Plasma arc or fast halogen light) OR 9-b 3 min Self cure material by applying OXYGUARD II to the margins. Then, wait 3 min. 7. Apply mixture of the paste. 8. Remove excess cement. (For easy clean up, partially light-cure the excess cement for 2-3 sec. with conventional halogen or LED light, then remove the excess.) #THE UNIVERSITY OF WESTERN AUSTRALIA THE UNIVERSITY OF WESTERN AUSTRALIA DUAL CURE DENTAL ADHESIVE SYSTEM PANAVIA F2.0 Cementation of precious & semi-precious metal crowns, PFM crowns, bridges, inlays and onlays. #### Panavia F 2.0 Final Steps for Metal/PFM 7. **Application:** Apply the mixed paste to the restoration. 8. **Cleanup:** Remove excess cement (optional 2-3 second tack cure for easier removal). **9. Final Polymerization (Choose A or B):** - **Option A (Light Cure):** 20 seconds per surface (Conventional/LED) or 5 seconds (Plasma/Fast halogen). - **Option B (Self Cure):** Apply OXYGUARD II to margins and wait 3 minutes. Procedural diagram illustrating steps 7 and 8 of the Panavia F2.0 cementation process. Step 7 shows a dental crown with orange cement paste being applied inside using a spatula, captioned 'Apply mixture of the paste.' Step 8 shows the crown seated on a tooth model with excess cement visible at the margin, captioned 'Remove excess cement' with instructions to partially light-cure for easy cleanup. Diagram labeled '9-a' demonstrating the light-curing phase. It depicts a metal crown on a tooth model under a curing light source. A text box provides specific timing instructions: 'Light cure the margins' requiring 20 seconds per surface for conventional halogen or LED light, and 5 seconds per surface for plasma arc or fast halogen light. Diagram labeled '9-b' showing an alternative self-curing method. It illustrates a syringe applying green liquid (OXYGUARD II) to the margins of a seated crown. The text instructs to apply OXYGUARD II to the margins and wait 3 minutes. **Guidelines** Lithium disilicate (LS2) Zirconium oxide (ZrO₂) IPS e.max® CAD IPS e.max® Press IPS e.max® ZirCAD IPS Ceramic Etching Gel Variobond Esthetic Multilink Automix Ivoclean® Monobond Plus Variobond Esthetic Multilink Automix Speedcem Plus Vivaglass® CEM Clean with Al₂O₃ at a maximum pressure of 1 bar (15 psi.) Try-in Conditioning Cementation adhesive Cementation self-adhesive / conventional _figures/img_0776fae4ca4c918b.webp) A comparative flowchart diagram illustrating the clinical workflow for dental ceramics. The left column outlines procedural steps including 'Production' (branching into Lithium disilicate and Zirconium oxide), 'Cementation' (Etching/Cleaning), 'Try-in', 'Cleaning after try-in', 'Conditioning', and 'Cementation'. The right column lists specific material brands corresponding to these steps, such as IPS e.max® CAD/Press, Monobond® Plus, and Speedcem® Plus Vivaglass® CEM. Several boxes on the right side are highlighted with green hand-drawn circles and arrows. **Thanks for listening** The University of Western Australia Anything you want to recap? [^1]: Original PDF page 1: [[DMD2 L3 Biomaterials (Cements).pdf#page=1|DMD2 L3 Biomaterials (Cements), p.1]] [^2]: Original PDF page 2: [[DMD2 L3 Biomaterials (Cements).pdf#page=2|DMD2 L3 Biomaterials (Cements), p.2]] [^3]: Original PDF page 3: [[DMD2 L3 Biomaterials (Cements).pdf#page=3|DMD2 L3 Biomaterials (Cements), p.3]] [^4]: Original PDF page 4: [[DMD2 L3 Biomaterials (Cements).pdf#page=4|DMD2 L3 Biomaterials (Cements), p.4]] [^5]: Original PDF page 5: [[DMD2 L3 Biomaterials (Cements).pdf#page=5|DMD2 L3 Biomaterials (Cements), p.5]] [^6]: Original PDF page 6: [[DMD2 L3 Biomaterials (Cements).pdf#page=6|DMD2 L3 Biomaterials (Cements), p.6]] [^7]: Original PDF page 7: [[DMD2 L3 Biomaterials (Cements).pdf#page=7|DMD2 L3 Biomaterials (Cements), p.7]] [^8]: Original PDF page 8: [[DMD2 L3 Biomaterials (Cements).pdf#page=8|DMD2 L3 Biomaterials (Cements), p.8]] [^9]: Original PDF page 9: [[DMD2 L3 Biomaterials (Cements).pdf#page=9|DMD2 L3 Biomaterials (Cements), p.9]] [^10]: Original PDF page 10: [[DMD2 L3 Biomaterials (Cements).pdf#page=10|DMD2 L3 Biomaterials (Cements), p.10]] [^11]: Original PDF page 11: [[DMD2 L3 Biomaterials (Cements).pdf#page=11|DMD2 L3 Biomaterials (Cements), p.11]] [^12]: Original PDF page 12: [[DMD2 L3 Biomaterials (Cements).pdf#page=12|DMD2 L3 Biomaterials (Cements), p.12]] [^13]: Original PDF page 13: [[DMD2 L3 Biomaterials (Cements).pdf#page=13|DMD2 L3 Biomaterials (Cements), p.13]] [^14]: Original PDF page 14: [[DMD2 L3 Biomaterials (Cements).pdf#page=14|DMD2 L3 Biomaterials (Cements), p.14]] [^15]: Original PDF page 15: [[DMD2 L3 Biomaterials (Cements).pdf#page=15|DMD2 L3 Biomaterials (Cements), p.15]] [^16]: Original PDF page 16: [[DMD2 L3 Biomaterials (Cements).pdf#page=16|DMD2 L3 Biomaterials (Cements), p.16]] [^17]: Original PDF page 17: [[DMD2 L3 Biomaterials (Cements).pdf#page=17|DMD2 L3 Biomaterials (Cements), p.17]] [^18]: Original PDF page 18: [[DMD2 L3 Biomaterials (Cements).pdf#page=18|DMD2 L3 Biomaterials (Cements), p.18]] [^19]: Original PDF page 19: [[DMD2 L3 Biomaterials (Cements).pdf#page=19|DMD2 L3 Biomaterials (Cements), p.19]] [^20]: Original PDF page 20: [[DMD2 L3 Biomaterials (Cements).pdf#page=20|DMD2 L3 Biomaterials (Cements), p.20]] [^21]: Original PDF page 21: [[DMD2 L3 Biomaterials (Cements).pdf#page=21|DMD2 L3 Biomaterials (Cements), p.21]] [^22]: Original PDF page 22: [[DMD2 L3 Biomaterials (Cements).pdf#page=22|DMD2 L3 Biomaterials (Cements), p.22]] [^23]: Original PDF page 23: [[DMD2 L3 Biomaterials (Cements).pdf#page=23|DMD2 L3 Biomaterials (Cements), p.23]] [^24]: Original PDF page 24: [[DMD2 L3 Biomaterials (Cements).pdf#page=24|DMD2 L3 Biomaterials (Cements), p.24]] [^25]: Original PDF page 25: [[DMD2 L3 Biomaterials (Cements).pdf#page=25|DMD2 L3 Biomaterials (Cements), p.25]] [^26]: Original PDF page 26: [[DMD2 L3 Biomaterials (Cements).pdf#page=26|DMD2 L3 Biomaterials (Cements), p.26]] [^27]: Original PDF page 27: [[DMD2 L3 Biomaterials (Cements).pdf#page=27|DMD2 L3 Biomaterials (Cements), p.27]] [^28]: Original PDF page 28: [[DMD2 L3 Biomaterials (Cements).pdf#page=28|DMD2 L3 Biomaterials (Cements), p.28]] [^29]: Original PDF page 29: [[DMD2 L3 Biomaterials (Cements).pdf#page=29|DMD2 L3 Biomaterials (Cements), p.29]] [^30]: Original PDF page 30: [[DMD2 L3 Biomaterials (Cements).pdf#page=30|DMD2 L3 Biomaterials (Cements), p.30]] [^31]: Original PDF page 31: [[DMD2 L3 Biomaterials (Cements).pdf#page=31|DMD2 L3 Biomaterials (Cements), p.31]] [^32]: Original PDF page 32: [[DMD2 L3 Biomaterials (Cements).pdf#page=32|DMD2 L3 Biomaterials (Cements), p.32]] [^33]: Original PDF page 33: [[DMD2 L3 Biomaterials (Cements).pdf#page=33|DMD2 L3 Biomaterials (Cements), p.33]] [^34]: Original PDF page 34: [[DMD2 L3 Biomaterials (Cements).pdf#page=34|DMD2 L3 Biomaterials (Cements), p.34]] [^35]: Original PDF page 35: [[DMD2 L3 Biomaterials (Cements).pdf#page=35|DMD2 L3 Biomaterials (Cements), p.35]] [^36]: Original PDF page 36: [[DMD2 L3 Biomaterials (Cements).pdf#page=36|DMD2 L3 Biomaterials (Cements), p.36]] [^37]: Original PDF page 37: [[DMD2 L3 Biomaterials (Cements).pdf#page=37|DMD2 L3 Biomaterials (Cements), p.37]] [^38]: Original PDF page 38: [[DMD2 L3 Biomaterials (Cements).pdf#page=38|DMD2 L3 Biomaterials (Cements), p.38]] [^39]: Original PDF page 39: [[DMD2 L3 Biomaterials (Cements).pdf#page=39|DMD2 L3 Biomaterials (Cements), p.39]]