CEMENTATION OF FIXED BRIDGE PROSTHESIS ZINC OXIDE-ROSIN-EUGENOL CEMENTS

DAVID

WITH

J. BARABAN,
Mass.

D.M.D."

Boston,

CEMENTATIOPI; OF FIXED bridge prosthesis with zinc oxide-rosin-eugenol cements (so-called temporary cements) has become a frequently used procedure. The objective of this technique is to allow an unhampered removal of the prosthesis by the dentist when it is deemed necessary. The advantages are numerous. However, clinical experience has shown that there are also disadvantages, and an evaluation of the efficacy of this technique is in order.

HE

The adoption of a zinc oxide-rosin-eugenol method of cementation is prompted by the fact that it provides the dentist with a means of coping with a variety of exigencies that may arise in conjunction with the use of a fixed bridge regardless of the length of its span.
RE.4SOKS FOR REMOVIPiG FIXED BRIDGES

If an abutment tooth fails, the fixed bridge may be removed, the offending tooth extracted, and the restoration can be altered and recemented. This obviates the necessity for destroying an expensive restoration in order to unseat it and, by so doing, rendering it useless. If the patient complains of pain in the area of the prosthesis but cannot localize it, the bridge can be removed to allow clinical inspection and pulp testing of the abutment teeth. If endodontic treatment is indicated for an abutment tooth, access to the canal(s) is simplified and more accurate when the restoration is not in position. If the prosthesis has acrylic resin veneers in the labial faces of the gold cast crowns, the instability of their color may promote objectional esthetic qualities over a period of time. Should this occur, removal of the restoration will allow for processing ne\v acrylic resin facings and the restoration of the esthetics. If the tissue underlying a pontic should become inflamed, this technique provides an opportunity for recontouring the pontic to achieve a more favorable toothto-tissue relationship.
Received for publication Jan. 24. 1958. *Associate ii Dental Surgery (Periodontia Section), Beth Israel Instructor in Periodontology, Graduate School of Medicine, University delphia, Pa. 988

Hospital, Boston, of Pennsylvania,

Mass. Phila-

CEMENTATION

OF

FIXED

BRIDGE

PROSTHESIS

ADDITIONAL

ADVANT,AGES

The abutment teeth are less sensitive to thermal changes when the prosthesis is cemented with zinc oxide-rosin-eugenol cements than when the oxyphosphate cements are used. The abutment teeth do not have to be absolutely dry n-hen zinc oxide-rosineugenol cements are employed. Their setting is enhanced by the presence of moisture. The working time of these cements, under normal conditions, is less critical than that of oxyphosphate cement. However, in the presence of high humidity, this advantage may be lost unless the bottles of liquid and powder are kept under refrigeration.
CRITERIA FOR TEMPORARY CEMENTATION

Temporary cementation should be used only with full coverage retainers. The rigidity of the margin of the full cast crown minimizes the possibility of a break in the seal and a washing out of the cementing meclium. This may occur more readily with inlay and 3/4 crown types of retainers. The marginal fit of the crowns must be accurate. The preparations of the teeth must be retentive hy virtue of their parallelism. Preparations that are too convergent are a bad risk for any type of cementation. In spite of the fact that all of these conditions may be met favorably, there is an element of risk with the use of this method of cementation. The cementing medium can and does wash out. Zinc oxide-rosin-eugenol cement not only lacks the adhesive quality of the oxyphosphate cement, but it is inferior in shearing strength. It never gets truly hard hut sets to a rubbery consistency. Thus, when an abutment retainer so cemented is subjected to torque as a result of flexure, the seal may be broken more readily. The danger is obvious, for if the washout goes unobserved hy both the patient and the dentist for a period of time, the abutment tooth may become carious, and the pulp may become exposed. Therefore, whenever temporary cementation is utilized, the patient should he apprised, not only of its advantages, but also of the innate risk involved. The patient should be advised that loosening of the bond about an abutment may be accompanied by a threefold syndrome that is unique to this situation : ( 1) sensitivity to thermal changes may develop in the area where the cement has washed out ; (2 ) sensitivity to biting pressure may develop in the same area ; and (3) a bad taste in the mouth may be noted. If these symptoms become apparent, no time should be lost in returning to the dentist for recementation. In many instances, the patient may not have any warning, and the washout may go unnoticed by him. Therefore, periodic checkups are an absolute necessity. If, for any reason, this is not possible, this procedure should be discarded in favor of permanent cementation. The only true clinical means for testing for a lvashout is to remove the bridge. However, a loosening of the bond on a terminal abutment may be detected by applying an unseating pressure with an instrument under the of saliva solder joint between the abutment and the adjacent pontic. BLlbl~ling at the gingival margin of the tooth, and an oozing sound indicate a break of the seal.

990
CAUSES OF WASHED-OUT CEMENT

BARABAN

The loosening of the bond is most commonly observed on a lone terminal abutment that is the only distal support for a span of two or three pontics. This failure may be explained on a purely mechanical basis. As Smydr has pointed out, any span supported by abutments will deflect when subjected to a vertical force. If an entire arch is splinted, the anterior abutments support one another against this flexure. However, a lone terminal abutment must counteract this flexure both by means of the resistance form of its preparation and by the shearing strength of the cement that is used as its bond. More often than not in the splinting of an entire arch, the distal wall of the terminal abutment converges mesially to a greater degree than in a simple crown preparation, in order to achieve parallelism with the anterior teeth. It is also quite common on upper molars that are normally inclined buccally to exaggerate the taper of the buccal wall of the preparation toward the lingual surface of the tooth. This is done to align it with the molar teeth on the opposite side of the arch so as to allow for a common path of insertion of the restoration. Thus, the preparation of the terminal molar abutment in a full arch splint is often quite tapered and lacks the retention and resistance form of an individual crown preparation. This, together with the use of zinc oxide-rosin-eugenol cement and the deflection of the restoration are the prime causative factors in the washouts encountered in these instances. To help overcome the weakness of the bond, the lone terminal abutments may be cemented with oxyphosphate cement to take advantage of its greater adhesiveness, and the remainder of the prosthesis can be cemented with zinc oxide-rosineugenol cement. The rationale for using the temporary cement on the intermediate abutmentsis that, despite the fact that one or two terminal abutments may be permanently cemented, removal of the bridge is still possible. Furthermore, washouts can and do occur with oxyphosphate cement as a result of the same mechanical stresses cited previously. Crowns of abutment teeth which lack retention form, as a result of decay or previous extensive restorations, should be made as telescope crowns in order to minimize the possibility of breakage of the seal made by the cement. This technique involves the permanent cementation on the tooth of a gold casting which has the external form of an ideal tooth preparation. Over this, the abutment crown may be cemented with temporary cement. Even if the temporary cement is washed out, there is no danger to the underlying tooth because it is protected by the internal gold casting. Where a fixed splint is utilized in conjunction with a removable precision attachment partial denture, permanent cementation of the attachment abutments is advisable to minimize the danger of unseating the splint as the removable prosthesis is being removed. The disadvantage of the potential washing out of the temporary cementing medium is outweighed by its many advantages. If the responsibility for maintenance of the fixed restorations so cemented is accepted and fulfilled by both the patient and the dentist, failures as a direct result of this technique can be eliminated.

Volume 8 Number 6

CEMENTATION

OF

FIXED

BRIDGE

PROSTHESIS

991

Another disadvantage of temporary cementation is the deleterious reaction of the eugenol upon acrylic resin restorations. To avoid such contamination, the gold faces of the acrylic veneer crowns must be devoid of openings. If peep holes were made at the metal try-in stage to check the accuracy of seating, these should be covered with a low fusing solder before the acrylic resin is processed. If this is not possible, any acrylic resin exposed on the inner surface of the crown should he protected with a silicone lubricant to prevent reaction between the eugenol and the resin. The coating of all exposed acrylic resin with such a lubricant during cementation helps to prevent adverse chemical reactions, and it provides for easier removal of the excess cement. It should be noted that because the zinc oxide-rosineugenol cements do not set to a brittle hardness, it is more difficult to remove the subgingival excess than to remove excess oxyphosphate cements. The gingival sulci must be checked carefully to make sure that no cement remains to produce an inflammatory reaction. A zinc oxide paste solvent should be used to make sure that no vestige of cement remains on the acrylic resin parts of the restoration.
SUMMARY

Clinical experience has shown that there is a justification for the cementation of fixed prosthesis by means of zinc oxide-rosin-eugenol cements. The successful employment of a temporary cementation technique depends upon the application of a thorough understanding of its disadvantages as well as its advantages.
REFERENCE

1. Smyd, E. S.: Mechanics of Dental Structures: Guide to Teaching Dental Engineering at Undergraduate Level, J. PROS. DEN. 2:668-692,1952. 358 COMMONWEALTH AVE.
BOSTON 15, MASS.