Dental cements

cons: #3 final

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.

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

TYPE I: Luting Cements

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.
(1) Permanent Cements
For the long-term cementation of cast restorations such as inlays, crowns, bridges, laminate
veneers, and orthodontic fixed appliances.
(2)Temporary cements
Temporary cements are used when the restoration will have to be removed. Most commonly,
temporary cement is selected for the placement of provisional coverage.
Calcium hydroxide (Dycal)
Zinc oxide eugenol (IRM
Nonzinc oxide eugenol (Cavit,Tempond)
Zinc polycarboxylate (Duralon)
Resins (Neo-Temp)

Characteristic of temporary cements

Simple to use
Easy to remove to allow final palcements of defenitive restorartion
Do not interfere with setting of defenitive material
Durable enough for few weeks
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 Biocompatible
Acceptably aesthetic

Luting Cements Requirements

Long working time
Adhere well to both tooth structure and cast alloys
Non toxic to the pulp
Adequate strength properties
Be compressible into thin layer
Low viscosity
Low solubility
Good working setting characteristics
Excess could be easily removed

TYPE II : Restorative Cements

Permanent Restoration
Temporary restoration

TYPE III : Bases & Liners

Materials used either to protect the pulp or aid pulpal recovery or both.
Pulpal irritants:

Heat generated during drilling

Some ingredient of various materials

Heat produced by restoartive materials

Forces transmitted to dentine through material

Galvaniv Shock

Ingress of noxious products and bacteriathrough microleakage

Selecting Base or line

Should be based on anatomical, physiological,and biological response characteristic of the pulp

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 Also based on the physical and chemical of the material considered for use.
Pulp response
Is reversibly proportional to the thickness of remaining dentine.
Cutting odontoblasts extension that have not been exposed to any irritating episodes of caries or
tooth wear would lead to death of these cells and their extensionsDead Tracts.(if remaining
dentine is 1.5 mm and more.
If the cutting was atraumatic and coolant was used,replacement odontoblasts would not be formed
hencefoth no reparative dentine would be produced.therefore base or liners are very important to
seal those empty tubules.
General Rule
Its desirable to have at least 2mm dimension of bulk between the pulp and metallic restoration,
this bulk may include remaining dentine, liner ,or base.
Since composite is thermal insulator and passively inserted, a liner is indicated only if the
excavation is judged to be within 0.5 mm of the pulp. (BW is important)

-Base and liners are materials placed between dentin (sometimes pulp) and the restoration to
provide pulpal protection .
1. Chemical protection
2. Electrical protection
3. Thermal protection
4. Mechanical protection
5. Pulpal medication
These functions differs as the depth of the restoration, and the type of restorative
material .

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>>Liners
Are relatively thin layers of material(0.5mm) used primarily as barrier between the
restoration and the remaining dentine following cavity preparation.
Liner Functions
Protective seal of exposed dentine
Electrical insulation
Thermal insolation ,which depends on remaining dentine.
Pulpal medicament :zinc oxide eugenol ,Ca(OH)2
Pulpal protection against

Residual reactants diffusing out of restoration(Chemical)

Oral fluid Leakage(bacterial Influx)

Types of Liners
Thin film liners(1-50m)

Solution liners =5m(Varnish)

Suspension Liners= 25m,Ca (OH)2 suspension

Thick Film Liners (cement Liners)= (0.2-1)mm

Pulpal mediacation

Thermal protection

-> Solution Liners:

natural resin dissolved in non-aqueous volatile solvent, (ether, alcohol and acetone
),after application it evaporate leaving resin on the cavity walls
These applied layer filled with pinholes, therefor multiple layers are indicated for an
optimum function
Do not dissolve in the oral cavity ,therefor can be used under: Amalgam,cast
gold,cohesive gold,ceramic restoration
Reduces discoloration by corrosion of amalgam,since it acts as dentinal seal.
(commercial BIS-GMA composite)
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 Should not be used under restoration that have organic solvent that reduces its value as
cavity varnish (commercial BIS-GMA composite )
dry rapidly
The solvent has anti microbial and antiviral action
Thermal insulating effect
Several fluoride-containing varnishes available (examples: Duraphat, Colgate Oral ).
reduction in caries ranging from 18% to 77%.
When amalgam is first placed, the tooth/amalgam interface is not microscopically sealed.
Eventually the varnish dissolves and is replaced with the corrosion products of the
amalgam .

->Cavity liner suspension :

These are suspension of calcium hydroxide,zinc oxide, and other material in resinous
solution
Used under tooth colored restoration
Have greater physical integrity
Have chemical neutralizing capacity for acids
Dissolve in oral fluids causing severe microleakage, therefore they should be applied on
dentine only, and do not extend to enamel.
Dry slowly
Provides thermal protection due to its increased thickness,with metallic restoartion
- Chemically cured forms Dycal, DENTSPLY Caulk) and light-cured forms :Prisma VLC Dycal,
DENTSPLY Caulk
Clinical implication
serves as an irritant stimulating the formation of reparative dentin;
the therapeutic affect of CH may be due to its ability to extract growth factors from the
dentin matrix. The result is the formation of a dentin bridge, which allows pulpal repair.
Which is the best liner?
The ability of calcium hydroxide to stimulate the formation of reparative dentine when it
is in contact with pulpal tissue makes the material of choice for very deep excavation.
Liners and bases in very deep excavation should be applied without pressure.
Ca(OH) should be 1mm thickness near potential or actual exposure .
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In these instances the base should be used in putty-like consistency ,so that less free
acid ,and elimination of the rotary

>>Cavity Bases
Those cements commonly used in thicker dimensions beneath permanent restorations to
provide for mechanical, chemical, thermal protection of the pulp.
Bases can be considered as restorative substitutes for the dentin that was removed by
caries and/or the cavity preparation.
1-Calcium Hydroxide Ca(OH)2
2-Zinc-Oxide Eugenol ZOE
3-Zinc Phosphate
4-Polycarboxylate
5-Zin-Silico-Phosphate
6-Glass Ionemer
7-Mineral trioxide aggregate (MTA)
8-Ca(OH)2+ZOE+MTA =Intermediary Bases

(1)Calcium Hydroxide
Has pH 11-13 therefore it can be used in deep cavity to neutralize the acids produced by
bacteria,and as sub-base to neutralize the irritating acidic components of base or
restoartive material
Its supplied in two forms:
* powder
*Paste (Dycal) :chemically set, or light curee

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(2)Zinc-Oxide Eugenol
Zinc-Oxide has pharmacological action on pulpal tissue,while Eugenol has topical
anesthetic property
AS Intermediate restorative material provide an excellent seal of the cavity preparation
ability of ZOE to reduce postoperative sensitivity
Has long setting time:The clinician should allow approximately 24 hours to pass prior to
placing amalgam above a ZOE base.
Low compressive strength
Eugenol interfers with polymerization of resin material therefore can,t be used
beneath,and substituted with Ca(OH)2.

Mixing : 3 scoops Powder+4 drops of liquids

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(3)Reinforced ZOE
chemical composition of ZOE is typically[3]:
Zinc oxide, ~69.0%
White rosin, ~29.3%
Zinc acetate, ~1.0% (improves strength)
Zinc stearate, ~0.7% (acts as accelerator)
Liquid (Eugenol, ~85%, Olive oil ~15%)

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(4)Zinc-Phosphate Cement
Powder:Zinc-Oxide
Liquid Phosphoric acid
Electrical and thermal insulator
Stay acidic after application ,therefore should be above Ca(OH)2 or ZOE in deep cavity
Has low linear of coefficient of thermal expansion
Compressive strength 100mpa
The material is acidic when placed (pH of approximately 3.5), but rises to a pH of 6.9 after
a week.

-Note-harder materials are more likely to have lower thermal expansion

The coefficient of thermal expansion describes how the size of an object changes with a
change in temperature. Specifically, it measures the fractional change in size per degree
change in temperature at a constant pressure. Several types of coefficients have been
developed: volumetric, area, and linear. Which is used depends on the particular
application and which dimensions are considered important. For solids, one might only be
concerned with the change along a length, or over some are

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Clinical consideration:.

ZP release irritants while setting, therefore dentine should be protected with varnish

Cements that are able to bond to dentine should have direct contact with dentine,
therefore varnish should not be used under GI or polycarboxylate cement or composite or
cearmic restration.

packages of ZOP contain 20% more liquid than is necessary to combine with the
powder. This is because some of the liquid will evaporate during use. This specification applies
to zinc phosphate, zinc polycarboxylate, and GI together since they all are water-based. This is
important for the clinician to consider. Since the water can evaporate, these materials can
become viscous, leading to difficulty in seating crowns. Furthermore, loss of water will result
in a decrease in the pH of the liquid, making the cement less biocompatible

(5)Zinc polycarboxylate Cement

Powder :Zinc Oxide
Liquid:Polyacrylic acid
As electrical and thermal insualtor
Has low linear of coeffecient of thermal expansion
Has adhesive bond to dentine only

(6)ZPC(Durelon )
Zinc polycarboxylate adheres to the tooth via an interaction be-tween the carboxylic acid
and the calcium in the dentin
Polyacrylic acid has a very low pH (1.7), but the pH approaches neutrality upon mixing
with the powder
the relatively large size of the polyacrylic acid molecule and/or its ability to combine with
protein prevents it from diffusing into dentin tubule
(7)Glass Ionomer
Powder: ion leachable glasses
Liquid;Copolymer of polyacrylic acids
Has thermal and electrical insulation effect
Compressive strength 120MPa
Has adhesive bond to enamel and dentine
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**Resin modified Glass Ionomer(Vitrebond)

first is their ability to ionically bond to tooth structure (between the carboxylate groups in
the GI and the calcium ions in the enamel and dentin)
They release fluoride
Reduction in the consequences of microleakage
antimicrobial propertiesits
ability to adhere to and seal the dentin
GIs should not be used as pulp-capping agents.In a clinical study, GI was found in the pulp
chamber, which triggered a persistent inflammatory response and appeared to prevent
the formation of dentin bridges.
They are extremely sensitive to moisture

, when GI comes in contact with water, there is a decrease in its physical properties.

In addition, resin-modified GIs expand after coming in contact with water.

caution is needed because certain materials are not compatible with each other. For
example, Yang and Chan demonstrated that varnishes can reduce the surface hardness of
glass ionomers.

(8)Zinc-Silico Phosphate Cement

Powder: Acid soluble silicate +Zinc+magnisium
Liquid:Phosphoric acids
Translucent and superior to the opaque ZP cement
Has flouride release ,this has caries inhibition effect
Has the same clinical application of ZP
High stength and translucency =cementation of ceramic restoration, but has been
replaced by GI and resin cements

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Clinical Considerations :
Selection Base or Liner depends on:
Thickness of remaining dentine
Adhesive property of both liner and base
Type of restoration placed above
When Dentine >2mm ,no need for pulpal protection ,and varnish is used against microleakage
at the intersurafce.
When remaining dentine is < 2mm ,Ca(OH), ZOE as liner or base .Eugenol acts as seadtive to
the pulp.ZOE contraindicated under resin restoration since it counteract polymeralization
obtundent :
1. having the power to dull sensibility or to soothe pain.
2. a soothing or partially anesthetic agent.
When remaining dentine is 0.5-1mm or near the pulp, use 1mm layer of Ca(OH)2 or MTA to
encourage reparative dentine.
Adhesive cement liners are used after removal of extensive carious dentine,GI bonds to Enamel
and dentine while polycarboxylate bonds to dentine only .

Resin Cement
Bond strength > Zinc phosphate 10 times
Retention
Reinforced ceramic - base Crown
Adhesive system (micromachanical bond-tooth)
(chemical bond-porcelain,metal)
Low solubility
leakage

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Modified ZOE
Addition of Zinc Acetate to powder setting time to 5min
Addition of 10% hydrogenated resin to powder strength (resin-bonded ZOE
Addition of EBA (ethoxy benzoic acid) 62% to liquid strength

Variables affecting the cement

The thicker the mix the greater the srtength
Heat setting time therefore cooled slab is advisable
Dip the mixing intrument with powder to stop sticking of cement to instrument during
placement
When luting,apply cement to restoartion before tooth.
Mixing time
Make sure to follow the manufactures directions for the mixing time, working time, and
delivery time.

Cavit G, Coltosol
Temporary restoration of cavities for short time periods (1-2 weeks)
Contraindicated incases of:

Allergy to components

Long temporization requirements

Temporary filling of cavities which include multiple areas and extend up to or under
the gingiva (subgingival)

Advantages:

Non eugenol formulation offers non irritating properties

Easy to use

packs and carves with no stringiness.

self-curing (light cure preparations are available) under humidity

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(9)Mineral trioxide aggregate (MTA)

root-end filling,
perforation repair,
vital pulp therapy,
apical barrier formation for teeth with necrotic pulps and open apexes.
Hydroxyapatite crystals form over MTA when it
comes in contact with tissue fluid. This can act as a nidus for the formation of calcified structures
after the use of this material in endodontic treatments
The compressive strength of MTA increased with time in presence of moisture.
Radiopacity is given by Bismuth Oxide.

MTA is less radiopaque than Super EBA, IRM, amalgam, and conventional gutta-percha,
but in the same range as zinc oxideeugenol-based root canal sealers.

better marginal adaptation to the root end cavity wall than other materials, and thus
preventing microleakage.
has antibacterial effects against Enterococcus faecalis and Streptococcus sanguis.
Biocompatible
Direct Pulp Capping
The formation, quality, and thickness of a calcified bridge.
presence of inflammatory cells,
preservation of the pulp are considered evaluation criteria after vital pulp therapy
Chemical Composition of MTA
1.Dicalcium silicate
2.Tricalcium silicate
3.Tricalcium aluminate
4.Gypsum
5.Tetracalcium aluminoferrite
6.Bismuth oxide
7.Manganese
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8.Strontium
9.Chromophores (iron oxide)
10.Aluminium
11.Potassium
MTA Drawbacks
long setting time
High cost
potential of discoloration
Resin cements
They are very versatile (generally being of high compressive and tensile strength.
possess low solubility
different viscosities and different shades
When resins are used as a cavity liner, it is important to remember that it is the dentin
bonding agent (examples: Clearfil SE Bond, Kuraray America; Excite, Ivoclar Vivadent) that
comes into contact with the dentin
Clinical consideration
Can,t be used for direct pulp cap(like GI)since they do not promote the formation of dentinal
bridge,however they elicit a persistent mild inflammatory pulpal response
adhesives placed below amalgam restorations reduce microleakage,thus supporting the
current trend toward this practice of using resin as a liner.
Lining cavities with copal varnish is faster and less technique-sensitive than using adhesive
resin, and resins cost more and have a limited shelf life.
Resin as liner
It has been observed that some adhesives do not bond well to dentin in deep cavity
preparations. This makes them more susceptible to polymerization shrinkage stress that
develops in deep cavities.

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To overcome shrinkage associated with resin restoartion in deep cavity

Sadwish Technique:in which the lining materials(Vitrebond) are brought to the cavosurface
margin
Advantage:Release F and the released flouride can be externally replaced
light-cured GI have been shown to provide a better seal

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