Cement 2

Other cements used in dentistry

1- Silicate cement: (Porcelain cement), (1873, Fletcher)

Silicate cements are said to have been introduced in 1873 by Fletcher as an

anterior esthetic filling material. They were translucent and resembled porcelain in
appearance. Though the initial esthetics was satisfactory, over a period of time
silicates degraded and stained. Leakage around the margins result in dark margins.

Silicates are attacked by oral fluids and in time degrade. The average life of
a silicate restoration is four years. Some may last as long as 25 years, others may
require replacement in a year or even less. The incidence of secondary caries is
markedly less around silicate restorations. This is surprising when considering that
severe leakage takes place at its margins. Also the incidence of contact caries is
less when compared to amalgam restorations (contact caries is the term applied to
caries occurring on the proximal surface of the tooth adjacent to the restoration).
The anticariogenic property is due to presence of 15% fluoride. Fluoride release is
slow and occurs throughout the life of the restoration. Silicate cements were
classed as a severe irritant to the pulp because of its low pH (acidic). For many
years silicate served as a standard for comparing the pulpal response to other
material. In deep cavities the pulp had to be protected with varnish or calcium
hydroxide. With the development of better alternate materials like composite
resin and glass ionomer cements, silicates gradually fell out of favor. By the 1980s
and 1990s they were gradually phased out of the market and are rarely used.
However, silicate cements are of historical interest as they were the first tooth
colored filling materials. It also forms the basis for the glass ionomer system.
Today, because of the development of composites, their usage has been abandoned.
Because;
- They require mechanical preparation.
- It has a low pH value.
- It is a good insulator and its thermal expansion coefficient is close to enamel
tissue
- Radiological appearance is radiolucent
- With sond, silicate cement gives a rough and crushed glass feel.

2- Zinc Silicophosphate Cements: (Silicon Phosphate Cements -Stone Cements-)

(Silicate cements and zinc phosphate cements + phosphoric acid combination).
Zinc silicophosphate cements (ZSPC) consist of a mixture of silicate glass and
zinc phosphate cement.
Composition:

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 Powder; contains an acid soluble silicate, zinc and magnesium oxides.
Liquid; is phosphoric acid.
Properties of Zinc Silicophosphate Cements
- Translucent and more esthetic than zinc phosphate cement
- Anticariogenic because of fluoride release from this cement
- Has sufficient strength.
This cement is not used nowadays.
Other materials that were used in dentistry are as follows;

1-CAVITY LINERS
A cavity liner is used like a cavity varnish to provide a barrier against the passage of
irritants from cements or other restorative materials and to reduce the sensitivity
of freshly prepared dentin. They are usually suspensions of zinc oxide or calcium
hydroxide in a volatile organic solvent (alcohol, chloroform). Upon the evaporation of
the volatile solvent, the liner forms a thin film on the prepared tooth surface.
Properties
Like varnishes, cavity liners neither possess mechanical strength nor provide any
significant thermal insulation. The calcium hydroxide liners are soluble and should
not be applied at the margins of restorations. Fluoride compounds are added to some
cavity liners in an attempt to reduce the possibility of secondary caries around
permanent restorations or to reduce sensitivity.
Manipulation
Cavity liners are fluid in consistency and can be easily flowed or painted over
dentinal surfaces. The solvents evaporate to leave a thin film residue that protects
the pulp.
* No mechanical resistance,
* Can not provide heat insulation( so is not used under amalgam filling )
* Melts in mouth fluids.
2- CAVITY VARNISH: Cavity varnish is a solution of one or more resins which
when applied onto the cavity walls, evaporates leaving a thin resin film, that serves
as a barrier between the restoration and the dentinal tubules. It is successful in
preventing the penetration of microleakage and corrosion products into dentin.

Some of the various commercially available varnishes.

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Application
1. It reduces microleakage around the margins of newly placed amalgam restorations,
thereby reducing, postoperative sensitivity.
2. It reduces passage of irritants into the dentinal tubules from the overlying
restoration or base, e.g. silicate.
3. In amalgam restorations, they also prevent penetration of corrosion products into
the dentinal tubules, thus, minimizing tooth discoloration.
4. Varnish may be used as a surface coating over certain restorations to protect
them from dehydration or contact with oral fluids, e.g. silicate and glass ionomer
restorations.
5. Varnish may be applied on the surface of metallic restoration as a temporary
protection in cases of galvanic shock.
6. When electrosurgery is to be done adjacent to metallic restorations, varnish
applied over the metallic restorations serves as a temporary electrical insulator.
7. Fluoride containing varnishes release fluoride.
Supplied As
Liquid in regular or-dark colored bottles. Commercial Names Harvard lac, Chem
Varnish, Secura, Fuji Varnish (GC)
Composition
Consists of a natural or synthetic resin dissolved in an organic solvent like alcohol,
acetone, chloroform. Medicinal agents such as chlorobutanol, thymol and eugenol may
be added. Some varnishes also contain fluorides.
Properties
Varnishes neither possess mechanical strength nor provide thermal insulation
because of the thin film thickness. The film thickness ranges from 2 to 400 μm. The
solubility of dental varnishes is low; they are virtually insoluble in water.
Manipulation
The varnish may be applied by using a brush, wire loop or a small pledget of cotton.
Several thin layers are applied. Each layer is allowed to dry before applying the next
one. When the first layer dries, small pinholes develop. These voids are filled in by
the succeeding varnish applications. The main objective is to attain a uniform and
continuous coating.
Precautions
1. Varnish solutions should be tightly capped immediately after use to prevent loss
of solvent by evaporation.
2. It should be applied in a thin consistency. Viscous varnish does not wet the cavity
walls properly. It should be thinned with an appropriate solvent.
3. Excess varnish should not be left on the margins of the restorations as it
prevents proper finishing of the margins of the restorations.
Clinical Considerations

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When placing a silicate restoration, the varnish should be confined to the dentin.
Varnish applied on the enamel inhibits the uptake of fluoride by the enamel.
Contraindications
- Composite resins; The solvent in the varnish may react with the resin.
- Glass ionomer; Varnish eliminates the potential for adhesion, if applied between
glass ionomer cement (GIC) and the cavity.
- When therapeutic action is expected from the overlying cement, e.g. zinc oxide
eugenol and calcium hydroxide.
3- FLUORIDE VARNISHES
Fluoride varnishes are used to prevent or arrest tooth decay in smooth surfaces in
young children, especially when applied before age three as their teeth erupt. The
taste does not appear to be offensive so is considered acceptable to young children.
The technique is well accepted by parents. It hardens on contact with saliva and stays
in contact with the teeth for several hours or days, but is not meant to adhere
permanently. Families should be told that their child can eat and drink afterward but
they should not brush the teeth until the next day, or at least 12 hours later, as it
may remove some of the varnish. Most protocols suggest two applications per year,
although some recommend up to four, with the first ones occurring fairly close
together or in the first 1–2 weeks.

Two commercially available fluoride varnishes. (A) Duraphat. (B) Fluor Protector.
Composition
Composition varies depending on the particular brand. It contains concentrated
fluoride dissolved in an organic solvent.
Manipulation
Fluoride varnishes are painted on to the teeth using a special tiny brush. The teeth
are cleaned with a toothbrush first and then dried with a gauze square; professional
tooth cleaning with prophylactic paste is not indicated. Some varnishes are colored
for visualization during placement.
Contraindications
Varnishes should not be used in cavitated carious lesions, but can be used to
remineralize white spot lesions.

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4- CALCIUM HYDROXİDE (CEMENTS): (CaOH2), (1930 Hermann)
Calcium hydroxide has high alkaline pH (11 to 13). Its alkaline pH helps in
neutralizing the acids produced by the microorganisms and irritating acidic
component of restorative base and materials. Calcium hydroxide also provide
antibacterial properties. Calcium hydroxide is a relatively weak cement commonly
employed as direct or indirect pulp capping agents. Due to their alkaline nature they
also serve as a protective barrier against irritants from certain restorations. A light
cured calcium hydroxide base material and a calcium hydroxide root canal sealing
paste is also available. It consists of a suspension of calcium hydroxide in water. The
main component is calcium hydroxide. (High quality slaked lime).
Calcium hydroxide can be used in:
• Powder form
• Quick setting paste form (Dycal) .
• Enjectable
Mixing Calcium Hydroxide Cement
• Calcium hydroxide mixing pad
• Calcium hydroxide applicator
• Spoon excavator
• Explorer
• Before placement of calcium hydroxide, check the dentin surface.
Dispense 1 mm of base and 1 mm of catalyst onto the mixing pad
• For mixing the two pastes, use either the calcium hydroxide applicator or spoon
excavator. Mixing should be done for 10 to 15 seconds until a uniform color is
achieved. Take a small amount of the calciumhydroxide, place it in the deepest
portion of the tooth preparation
• Check the setting of calcium hydroxide using the tip of an explorer with minimal
pressure
Applications
1. For direct and indirect pulp capping.
2. As low strength bases beneath restorations for pulp protection.
3. Apexification procedure in young permanent teeth where root formation is
incomplete.
4. In the treatment of root canal antiseptic and root canal.
Properties
Calcium hydroxide cements have poor mechanical properties.
Mechanical properties
Compressive strength (10-27 MPa after 24 hours). It has a low compressive
strength. The strength continues to increase with time.
Tensile strength (1.0 MPa) is low.
Modulus of elasticity (0.37 GPa/m2). The low elastic modulus limits their use to
areas not critical to the support of the restoration.

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Thermal properties
If used in sufficiently thick layers they provide some thermal insulation.
However, a thickness greater than 0.5 mm is not recommended.
Thermal protection should be provided with a separate base.
Solubility and disintegration
The solubility in water is high. Some solubility of the calcium hydroxide cement is
necessary to achieve its therapeutic properties. Solubility is higher when exposed to
phosphoric acid and ether. So care should be taken during acid etching and during
application of varnish in the presence of this cement.
Biological properties
Effect on pulp: The cement is alkaline in nature. The high pH is due to the presence
of free Ca(OH)2 in the set cement. The pH ranges from 9.2 to 11.7.
Formation of tertiary dentin: The high alkalinity and its consequent antibacterial
and protein lysing effect helps in the formation of reparative dentin.
Adhesion
The material is sensitive to moisture and does not adhere in the presence of blood,
water or saliva. The adhesive bond is weak.
Manipulation
Equal lengths of the two pastes are dispensed on a paper and mixed to a uniform
color. The material is carried and applied using a calcium hydroxide carrier or
applicator (a ball-ended instrument). It is applied to deep areas of the cavity or
directly over mildly exposed pulp (contraindicated if there is active bleeding).
Setting Time
Ranges from 2.5 to 5.5 minutes.
Factors affecting setting time: The reaction is greatly accelerated by moisture and
accelerators. It therefore sets faster in the mouth.
* It is applied to the cavity base and dries to form a layer of calcium hydroxide.
* These materials are difficult to work with, they break easily, forms fractured
layers.
* Most of the Calcium Hydroxide pastes used today are as two-paste system that
harden by mixing.
Properties of calcium hydroxide:
- They have therapeutic effect
- Texture friend
- pH is 11
- It has disinfectant and bactericidal properties, especially aerop m.o.
- Diluted CaOH2 has a hemostatic effect.
- Solubility in oral fluids is high.
- Improves repair dentin formation rate
- It is used as a pulp capping* agent

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* Pulp Capping
Pulp capping is the process of placing a specialized agent in contact with or in close
proximity to the pulp with the intention of encouraging formation of new dentin
(tertiary dentin) and promote the healing of the pulp. Prior to the discovery of pulp
capping agents, a pulp exposure often led to irreversible pulpitis or pulpal infection
and ultimately pulp necrosis. Thanks to these pulp capping agents, it became possible
to treat pulpal tissue which otherwise would have had to undergo root canal therapy.
Example of a pulp capping agent is calcium hydroxide cement. When dissolved, Ca +
and OH- ions are formed. Hydroxyl ions have a lethal effect on bacteria and blocks
Ca + enzymes.
Criteria For Pulp Capping
Are all exposed pulps suitable for pulp capping therapy?
The answer is obviously no. The dentist has to apply certain criteria and select his
cases carefully.
1- The pulp should be healthy and non infected.
2. The area of exposure should be no more than 0.5 mm.
3. Following exposure the dentist should make all attempts to immediately isolate
the tooth and prevent contamination.
Types of Pulp Capping
A. Direct pulp capping
B. Indirect pulp capping
Direct Pulp Capping
Direct pulp capping is the placement of the agent directly on the exposed pulp. Such
a situation is often encountered during
1. The excavation of deep carious lesions when the dentist accidentally exposes the
pulp.
2. Traumatic fractures of the tooth.
3. Iatrogenic (The definition of iatrogenic is a complication that happens to a patient
from the phsysician usually unintentionally) exposure during cavity preparation.
4. Iatrogenic exposure during crown preparation.
Indirect Pulp Capping
Tertiary dentin formation can be induced even when the pulp is not exposed but is
near exposure. When the calcium hydroxide is placed in the region of the near
exposure, it can still induce new dentin formation. This is known as indirect pulp
capping.
Indications
1. Deep carious lesions close to the pulp.
2. During excessive crown preparation the pulp is often visible through the
remaining dentin as a pinkish or reddish spot or area.
3. Similar near exposures may be seen in cases of traumatic tooth fracture