Chapter 45

Dental Cements
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Introduction
Dental cements are a classification of dental materials that are continually used in dentistry. The American Dental Association and the International Standards Organization (ISO) have teamed up to classify dental cements according to their properties and their intended uses in dentistry.

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Classification of Cements
 Type I: Luting agents that include
permanent and temporary cements.  Type II: Restorative applications.  Type III: Liner or base applications.

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Luting Agent
 A material that acts as an adhesive to hold
together the casting to the tooth structure. Luting agents are designed to be either permanent or temporary.

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Permanent Cement
 For the long-term cementation of cast
restorations such as inlays, crowns, bridges, laminate veneers, and orthodontic fixed appliances.

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Temporary Cement
 Temporary cements are used when the
restoration will have to be removed. Most commonly, temporary cement is selected for the placement of provisional coverage.

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Variables Affecting Cements

 Mixing time
Make sure to follow the manufacture s directions for the mixing time, working time, and delivery time.  Humidity If the clinical area is warm or humid, premature exposure of the cement to these environments can create a loss of water from the liquid or an addition of moisture to the powder.

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Variables Affecting Cementscontd

 Powder to liquid ratio
Incorporating too much or too little powder will alter the consistency.  Temperature Some types of cements put off an exothermic reaction.

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Mixing Dental Cements

 Before mixing, read and carefully follow the
manufacturer's directions for the brand being mixed.  Determine the use and then measure the powder and liquid according to the manufacturer's instructions.  Place the powder toward one end of the glass slab or paper pad and the liquid toward the opposite end (the space between allows room for mixing).

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Mixing Dental Cementscontd

 Divide the powder into increments.  When increment sizes vary, the smaller
increments are used first.  Incorporate each powder increment into the liquid and then mix thoroughly.

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Types of Cements
    
Zinc-oxide eugenol Zinc phosphate Polycarboxylate Glass ionomer Composite resin

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Zinc Oxide Eugenol

 Chemical Makeup
Liquid: Eugenol, H2O, acetic acid, zinc acetate, and calcium chloride. Powder: Zinc oxide, magnesium oxide, and silica.

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Types of Zinc-Oxide Eugenol

 Type I
Lacks strength and long-term durability and is used for temporary cementation of provisional coverage.  Type II Has reinforcing agents added and is used for the permanent cementation of cast restorations or appliances.

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Supply of Zinc-Oxide Eugenol

 Liquid/Powder
Mixed on an oil-resistant paper pad. Mixing time ranges from 30 to 60 seconds. Setting time in the mouth ranges from 3 to 5 minutes.  Paste Supplied as a two-paste system as temporary cement. Pastes are dispensed in equal lengths on a paper pad and mixed.

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Zinc Phosphate
 Chemical Makeup
Liquid: Phosphoric acid, aluminum phosphate, and water. Powder: Zinc oxide, magnesium oxide, and silica.

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Types of Zinc Phosphate

 Type I (fine grain)
Used for the permanent cementation of cast restorations such as crowns, inlays, onlays, and bridges. This material creates the very thin film layer that is necessary for accurate seating of castings.  Type II (medium grain) Recommended for use as an insulating base for deep cavity preparations.

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Supply of Zinc Phosphate

 Powder/liquid
Powder is divided into increments that vary in size. It is critical that the powder be added to the liquid in very small increments. Cement must be spatulated slowly over a wide area of a cool, dry, thick glass slab to dissipate the heat.

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Polycarboxylate Cements
 Chemical Makeup
Liquid: Polyacrylic acid, itaconic acid, maleic acid, tartaric acid, and water Powder: Zinc oxide

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Use of Polycarboxylate
 Used as a permanent cement for cast
restorations, stainless steel crowns, and orthodontic bands.  Used as a nonirritating base under both composite or amalgam restorations.  Used as an intermediate restoration.

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Supply of Polycarboxylate
 Powder/liquid
Liquid may be measured by using either the plastic squeeze bottle or the calibrated syringe-type liquid dispenser. Liquid has a limited shelf life because it thickens as its water evaporates. Mixed on a nonabsorbent paper pad.

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Glass Ionomer
 Chemical Makeup
Liquid: Itaconic acid, tartaric acid, maleic acid, and water. Powder: Zinc oxide, aluminum oxide, and calcium.

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Types of Glass Ionomer

 Type I
For the cementation of metal restorations and direct-bonded orthodontic brackets.  Type II Designed for restoring areas of erosion near the gingiva.  Type III Used as liners and dentin bonding agents.

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Benefits of Glass Ionomer

 Powder is an acid-soluble calcium. The slow    
release of fluoride from this powder aids in inhibiting recurrent decay. Causes less trauma or shock to the pulp than many other types of cements. Low solubility in the mouth. Adheres to a slightly moist tooth surface. Has a very thin film thickness, which is excellent for seating ease.

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Supply of Glass Ionomer

 Powder/liquid
Mixed manually on a paper pad or a cool, dry glass slab. Glass slab increases the working time of the cement.  Premeasured capsules Triturated and expressed through a dispenser.

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Composite Resin
 Chemical Makeup
Physical properties are comparable to those of composite resins. Low film thickness. Insoluble in the mouth.

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Uses of Composite Resin

 Cementation of ceramic or resin inlays and    
onlays. Cementation of ceramic veneers. Cementation of orthodontic bands. Direct bonding of orthodontic brackets. Cementation of all metal castings.

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Supply of Composite Resin

   
Powder and liquid mix Syringe-type applicator Base and catalyst Light cure/dual cure system Recommended portions of either application are dispensed onto a paper pad and mixed rapidly with a spatula.

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Cement Removal
 Operator preparedness and knowledge
Instruments selected for the procedure: Explorer, mouth mirror, black spoon. Use of a fulcrum. Use of dental floss in and around the embrasure areas.

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