CEMENTATION IN FPD

PRESENTED BY: NIHARIKA SABHARWAL (2nd YEAR PG)

GUIDED BY: DR VIRAM UPADHYAYA (READER)
DEPTT OF PROSTHODONTICS, CROWN AND BRIDGE
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 CONTENTS
1. INTRODUCTION
2. LUTING AGENTS
3. PROPERTIES OF LUTING AGENTS
4. STEPS IN CEMENTATION
• CEMENT SELECTION
• SURFACE TREATMENT
• ISOLATION
• CEMENTATION
• REMOVAL OF EXCESS CEMENT
• POST CEMENTATION INSTRUCTIONS
5. REVIEW OF LITERATURE
6. REFERENCES
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 INTRODUCTION
• How do we keep our restorations stuck to the teeth
for as long as possible?
• How do we choose materials that last for many years
without sensitivity, leakage, fracture or failure?

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 LUTING AGENTS
• Ensure the stability of fixed prostheses
throughout their serviceable lifespan.
Luting Agents

Interim Luting Agents Definitive Luting Agents

Water Based Polymer Based

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 General Requirements
• Long working time
• Adheres well to both tooth structure and restorative
materials
• Marginal seal
• Biocompatibility
• Mechanical properties
• Low film thickness
• Low viscosity and solubility
• Ease of use
• Radiopacity
• Esthetics

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 Commonly Used Luting Agents
1. Zinc phosphate cement
2. Zinc polycarboxylate cement
3. Glass Ionomer cement
4. Zinc oxide eugenol with and without ethoxybenzoic acid
5. Resin-modified glass ionomer luting agents
6. Resin luting agents

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07/06/2024 7
 Advantages

DV, Sita Ramaraju, et al. "A Review of Conventional and Contemporary Luting Agents Used in Dentistry." American
Journal of Materials Science and Engineering 2.3 (2014): 28-35
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 Disadvantages

DV, Sita Ramaraju, et al. "A Review of Conventional and Contemporary Luting Agents Used in Dentistry." American
Journal of Materials Science and Engineering 2.3 (2014): 28-35
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 Indications/Contra-indications

DV, Sita Ramaraju, et al. "A Review of Conventional and Contemporary Luting Agents Used
07/06/2024 10
in
Dentistry." American Journal of Materials Science and Engineering 2.3 (2014): 28-35
 STEPS IN CEMENTATION
1. SELECTION OF LUTING AGENT

• Type of restoration – metal or ceramic

• Resistance and retentive form of the prepared
tooth
• History of patient’s experience

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FACTORS TO CONSIDER WHILE SELECTING A RESIN CEMENT:

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2. SURFACE TREATMENT

METAL ALLOYS

• Metal alloys can be classified into non-

precious (for example, nickel chromium and
cobalt chromium) and precious (for example,
type IV gold and palladium rich).

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 NON PRECIOUS ALLOYS
• Readily form an oxide surface layer
that chemically bonds to the
phosphate ester groups of MDP.
• Predictable adhesive bonding can be
achieved
• APA (air particle abrasion) is used to
roughen the metal surface and
promote micromechanical retention of
the resin cement.
• ultrasonic bath cleaning to remove
loosely retained alumina particles that
could reduce resin bond strength to
the alloy
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PRECIOUS ALLOYS
• Do not provide a convenient oxide layer
compatible with MDP bonding.
• The following methods have been tested
and shown to produce a clinically
acceptable bond strength to resin:
1. Heat treating the metal in the laboratory
(to force a copper oxide layer to form)
followed by MDP.
2. Tribochemical coating followed by silane
coupling agent.
3. APA followed by a primer containing
specific sulphate monomers that
chemically adhere to the precious metal
surface
14
 CERAMICS

ACID SENSITIVE CERAMICS ACID RESISTANT CERAMICS

Glass infiltrated ceramics (In- Ceram

Spinell, Alumina and Zirconia
Feldspathic ceramics, leucite
systems), densely sintered
enhanced feldspathic ceramics (IPS
aluminized ceramics (Procera
Empress), and lithium disilicate (IPS
AllCeram), and ceramics based on
Empress II) ceramics.
zirconia partially stabilized by
yttrium oxide.

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 GLASS CERAMICS

• The chemical process of conditioning with

hydrofluoric acid causes a reaction with the
glassy phase of leucite-reinforced ceramics,
resulting in hexafluorsilicate.

• These silicates are removed by the jet of

water forming a honeycomb surface that is
ideal for the cement micromechanical
retention.

• This is the surface treatment of choice for

ceramics with feldspar or vitreous silica in a
2.5-10 percent of hydrofluoric acid for 20
seconds to 3 minutes, and subsequent
application of silane.

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• Lithium or feldspathic disilicate ceramics are frequently used
with 10% hydrofluoric acid and silane application.

• The 10% hydrofluoric acid conditioning is designed for two

minutes. However, it may vary according to the composition
of the ceramic used.

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 SILANIZATION

• As the silane will react with the hydroxyl group of the porcelain
surface, it allows for the chemical adhesion by making it more
reactive to the composite.

STEPS:
1. This bonding agent must be used in the ceramic with a
disposable brush for one minute.
2. Air-dried using a triple syringe for five seconds before applying
the adhesive system.
3. In order to stimulate the reaction between the silane coupling
agent and the inorganic surfaces of the ceramic, the reaction
can be catalyzed by heating the silane agent.
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 ZIRCONIA

•Reduced glassy matrix and silica-content.

•Acid etching plus silane application incapable of modifying and treating
the zirconia surface, with no apparent improvement in bond strength.

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Adhesive cementation is preferred for zirconia
crowns because of:
• Improved retention
• Marginal adaptation
• Fracture resistance
• Reduced possibility of recurrent decay
• Enables more conservative tooth preparation

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 Surface Treatment Methods for Zirconia

1. Use of a phosphate-modified monomer (MDP) in resin

cement
2. Laboratory or chairside air-abrasion with 110 and 30
𝜇m Si-coated aluminum particles
3. The use of zirconate coupler primers
4. Tetraethoxysilane flame-treat device usage
5. The use of organofunctional silanes
6. Laser irradiation
7. The Si vapor phase deposition method and
8. The selective infiltration etching procedure
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 Chemical Surface Treatments
1. HYDROFLUORIC ACID ETCHING
• HF removes the glassy matrix of glass ceramics creating a high surface
energy substrate with microporosities for the penetration and
polymerization of resin composites, that is, enabling a micromechanical
interlocking .
• Does not produce any change in arithmetic roughness (Ra) of ZrO2.

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2. FUNCTIONAL MONOMERS

• 10-methacryloyloxyidecyl-dihyidrogenphosphate (MDP)
•BIS-GMA based resin cement
•6-methacryloyloxyhexyl phosphonoacetate (6-MHPA)
•MEPS (thiophosphoric methacrylate)
•6-[4-vinylbenzyln-propyl]amino-1,3,5-triazine-2,4-dithione (VBATDT)
•6- methacryloyloxyhexyl-2-thiouracil-5-carboxylate (MTU-6)
•4-methacryloxyethyl trimellitic anhydride (4-META)

Since results are not always significant, the combination of primers and air-
abrasion methods tend to produce better bond strength, especially in longterm.

The surface treatment with primers containing functional monomers such as

MDP (e.g., Alloy Primer and Clearfil Ceramic Primer, Kuraray Medical Inc., Japan) or
other phosphoric acid acrylate monomer (e.g., Metal/Zirconia Primer, Ivoclar-
Vivadent) are often recommended to improve the bonding to ZrO2.

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3. SILANE COUPLING AGENTS
• Also called trialkoxy silanes
• Hybrid inorganic-organic bifunctional molecules that are able
to create a siloxane network with the hydroxyl (OH) of the Si
in the ceramic surface and copolymerize with the resin
matrix of composites.
• Lower the surface tension of a substrate, wet it, and make its
surface energy higher.

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 Different types of silanes have been studied, but
none of them were able to show high effectiveness in
surfaces with absent or reduced Si content as the
surface of ZrO2.

 Organosilanes were also tested (3-

methacryloyloxypropyltrimethoxysilane, 3-
acryloyloxypropyltrimethoxysilane, or 3-
isocyanatopropyltriethoxysilane) with better results
for the two first ones.

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 Mechanical Surface Treatments
1. AIR ABRASION WITH ALUMINIUM OXIDE PARTICLES
• When it comes to abrasion with Al2O3, a wide range of
particle size, pressure, distance from ceramic surface,
working time, and impact angle have been studied.

• On a yttrium stabilized tetragonal zirconia (Y-TZP) material,

the use of greater particle size (from 50 𝜇m to 150 𝜇m)
results in a rougher surface but no significant alteration in
bond strength.

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Evaluating a Y-TZP, Cavalcanti et al. showed an increase in bond
strength after air-abrasion with 50 𝜇m Al2O3 for 15 seconds at
2.5 bars.

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 2. SI DEPOSITION METHODS
• Silicoater technology (1984)
• Rocatec system (1989)
• CoJet system

These systems are based on the use of

110 𝜇m (Rocatec) or 30 𝜇m (CoJet) Si-
coated alumina particles that are blasted
onto the ceramic surface.

The tribochemical Si-coating on ceramic surfaces increases the bond strength of

resin cement to glass-infiltrated ZrO2 or Y-TZP. Usually, 2.5–2.8-bar air-abrasion
pressures are used; however, higher pressure results in higher bond strength with
CoJet

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 Alternative Treatments
1. PLASMA SPRAYING (HEXAMETHYLDISILOXANE) USING A
REACTOR (PLASMA ELECTRONIC, GERMANY).
• Increased the bond strength of resin cement to ZrO2

T. Derand, M. Molin, and K. Kvam, “Bond strength of composite luting cement to zirconia
ceramic surfaces,” Dental Materials, vol. 21, no. 12, pp. 1158–1162, 2005
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2. LASER APPLICATION
• Erbium-doped yttrium aluminum garnet (Er:YAG) or CO2 laser.
• Laser application removed particles by microexplosions and
by vaporization, a process called ablation.

3. The applications of micropearls of low fusing porcelain or

vapor deposition of silicon tetrachloride (SiCl4) are other
types of silicatization methods that have been used, showing
improved bond strength

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 4. SELECTIVE INFILTRATION ETCHING
• Principle: heat-induced maturation and grain boundary diffusion to
transform the relatively smooth non-retentive surface of Y-TZP into a
highly retentive surface.

• A low temperature molting glass is applied on selected ZrO2 surfaces and

submitted to a heat-induced infiltration process, determining zirconia
crystal rearrangements.

• Glass is removed with a 5% hydrofluoric acid solution bath, leaving

intergrain nanoporosities where low-viscosity resin materials may flow
and interlock after polymerization.

M. N. Aboushelib, C. J. Kleverlaan, and A. J. Feilzer, “Selective infiltration-etching technique for a strong and durable bond
of resin cements to zirconia-based materials,” Journal of Prosthetic Dentistry, vol. 98, no. 5, pp. 379–388, 2007

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 Try-In Procedure for Crowns
1. CHECKING THE CROWN ON THE DIE
• Marginal fit, aesthetics and articulation can be anticipated prior to try in.

•Always check the fit surface of the crown for defects and the die for damage,
preferably with a good light and under magnification.

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07/06/2024 33
2. SEATING THE CROWN
•Any temporary restoration is removed and the preparation is carefully cleaned of
all residues of temporary cement, especially in retention grooves.

•The crown should be tried in without forcing it onto its preparation; if it fails to
seat there are a range of reasons why this may have happened. It pays to use a
systematic approach to localise problems:

1. First, ensure there is no retained temporary cement or trapped gingival tissue

2. Then check and adjust tight proximal contacts as these often prevent seating.
Also check the original cast for damage to the stone in these contact areas.

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3. Then re-check the crown for the most obvious laboratory errors, including
casting blebs, damaged or chipped dies or grossly overextended margins.
Casting blebs can be removed with a bur. Over-extended margins should
be adjusted from the axial surface, not from underneath. To avoid the
abrasive dragging metal over the margin, run the disc so that the abrasive
travels in the direction of the occlusal surface, not towards the margin.

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3. ASSESSMENT OF THE SEATED CROWN

Proximal contacts
The tightness of proximal contacts can be tested with dental
floss and should offer some resistance but not make its
passage too difficult.

Assessment of marginal fit

Poor fit can present as a gap or an overhanging margin
(positive ledge) or deficient margin (negative ledge).
Overextended margins and positive ledges may be corrected
by adjusting the crown from its axial surface until it is possible
to pass a probe from tooth to crown without it catching.

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Aesthetics
• Grinding with diamond burs can alter crown contours and
porcelain additions can be made to metal ceramic crowns if
necessary.
• Shades that are slightly too light may be darkened by the
addition of stain and re-firing while all ceramic crowns with
no cores may have their shade modified slightly by the luting
composite in the same way as veneers.

Assessment of the occlusion

• It is best to remove the seated crown and identify a pair of
adjacent occluding teeth, termed index teeth, which, after re-
seating, can be used to assess visually, and with shim stock,
how much adjustment is needed.
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 ISOLATION AND CEMENTATION
The following equipment is needed
• Mirror
• Explorer
• Dental floss
• Cotton rolls
• Prophylaxis cup
• Flour of pumice
• Cement
• White stones
• Cuttle disks
• Local anesthetic (if needed)
• Saliva evacuator
• Forceps
• Thick glass slab (chilled)
• Cement spatula
• Gauze squares
• Adhesive foil
• Plastic instrument
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 • Clean the preparation and crown with water
spray
• Air dry but do not desiccate preparation
• Mix cement according to manufacturer's
instructions
• Coat the fit surface with cement – do not
overfill
• Only apply cement to preparation if cementing
a post

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• The crown should be seated quickly with firm finger pressure until all
excess cement has been expressed from the margins.

• Depending on the angulation of the tooth, pressure may then continue

to be exerted onto the crown by the dentist or by the patient biting
onto a cotton roll.

• Pressure should be maintained for about one minute. Maintaining

pressure beyond this time has no appreciable additional effect.

• Adequate moisture control should be maintained until the cement has

set.
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 Cut a length of dental floss
Knot the center portion of
for each pontic space or each
each piece of floss
embrasure space

Loop each piece of floss

around the prosthesis and
hold the floss securely in the
palm of one hand while
pinching it with fingers of
that hand

Follow the protocol for

having the patient bite the
Place the luting material of
prosthesis into its seated
your choice into the
position, leaving the floss
prosthesis
hanging out of the patient’s
mouth
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 Use an instrument Use the pieces of floss
already in the embrasure or
to remove excess pontic areas to thoroughly
cement clean away residual cement

Using a mirror show

the patient the oral
hygiene technique to
use the new prosthesis

Pull the knot in the floss

back and forth under the
prosthesis to provide
additional cleaning force

Youngblood A. A safe and convenient technique for the cementation of fixed partial dentures.
JADA07/06/2024
2002; 133(10): 1381-1382. 42
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07/06/2024 44
Zitzmann, Nicola & Özcan, Mutlu & Scherrer, Susanne & Bühler, Julia & Weiger, Roland & Krastl, Gabriel. (2015). Resin-bonded restorations: A
strategy07/06/2024
for managing anterior tooth loss in adolescence. The Journal of prosthetic dentistry. 113. 10.1016/j.prosdent.2014.09.028. 45
 Post Cementation Instructions
FIRST APPOINTMENT
• Crown preparation- Following the first appointment you will receive a temporary
crown that is placed and cemented to the prepared tooth.

• Because temporary cement washes out rapidly, you may experience some sensitivity
to cold and hot.

• Try to brush the area gently and when you floss, pull the floss out from the side
rather than upward. The rapid upward motion may dislodge the temporary crown.

• If a temporary crown becomes loose or falls out, clean the temporary cement from
the inside the crown, then apply vaseline inside the crown and place it back on the
tooth.

• Immediately call and come back to the office to get the crown either re-cemented or
re-fabricated.
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SECOND APPOINTMENT
• Final cementation- Please do not eat or drink for 30 minutes after your new
crown is cemented.

• Do not eat hard or sticky foods for 24 hours while the cement completely
sets.

• Your new crown may feel tight or as if it is pushing against the teeth next to
it for several hours. This discomfort will go away within a day or two.

• Sensitivity, especially to hot and cold is common after a crown is cemented.

This may be the results of chemical reaction between the final cement and
the tooth. The sensitivity usually subsides within a week or ten days. Usually
the deeper the cavity, the more sensitive the tooth will be. You should make
an adjustment appointment if the sensitivity persists or increases.

apexdentalnm.com/PDF/Crown%20And%20Bridge%20Instructions.pdf
07/06/2024 47
• The finished restoration may be contoured slightly different
and have a different texture than the original tooth. Your
tongue usually magnifies this small difference, but you will
become accustomed to this in a few days.

• Please follow prescribed oral hygiene instructions-45 degree

angle brushing twice a day and flossing once a day to avoid
getting a cavity or gum disease around your new crown.
Flossing is especially important in preserving the health of
your crown or bridge.

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 REVIEW OF LITERATURE

1. Does adhesive cementation, as compared to conventional cementation,

improve clinical performance and limit complications of lithium disilicate
and zirconia tooth–supported single crowns?
The authors concluded that zirconia and lithium disilicate tooth–supported
crowns exhibited comparable survival rates and complication patterns
regardless of the type of cementation.

Effect of cement type on the clinical performance and complications of zirconia and lithium disilicate
tooth–supported crowns: A systematic review. Report of the Committee on Research in Fixed
Prosthodontics of the American Academy of Fixed Prosthodontics. Maroulakos G, Thompson GA,
Kontogiorgos ED. J Prosthet Dent 2019;121:754-65.

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 2. Malysa A et al carried out a systematic review to study the effect of different
surface treatment methods on bond strength of dental ceramics to dental hard tissues
The present review of laboratory studies revealed a statistically significant difference in
bond strength between the samples treated with different surface conditioning
methods, or between conditioned and non-conditioned samples. Based on the results
analyzed, a combination of mechanical and chemical methods is proposed as the most
effective way of enhancing bond strength.

Malysa, A.; Wezgowiec, J.; Orzeszek, S.; Florjanski, W.; Zietek, M.; Wieckiewicz, M. Effect of Different
Surface Treatment Methods on Bond Strength of Dental Ceramics to Dental Hard Tissues: A
Systematic Review. Molecules 2021, 26, 1223.

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 SUMMARY

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 References
1. DV, Sita Ramaraju, et al. "A Review of Conventional and Contemporary Luting Agents Used in
Dentistry." American Journal of Materials Science and Engineering 2.3 (2014): 28-35.
2. Malysa, A.; Wezgowiec, J.; Orzeszek, S.; Florjanski, W.; Zietek, M.; Wieckiewicz, M. Effect of Different Surface
Treatment Methods on Bond Strength of Dental Ceramics to Dental Hard Tissues: A Systematic Review.
Molecules 2021, 26, 1223.
3. Zitzmann, Nicola & Özcan, Mutlu & Scherrer, Susanne & Bühler, Julia & Weiger, Roland & Krastl, Gabriel.
(2015). Resin-bonded restorations: A strategy for managing anterior tooth loss in adolescence. The Journal of
prosthetic dentistry. 113. 10.1016/j.prosdent.2014.09.028.
4. Effect of cement type on the clinical performance and complications of zirconia and lithium disilicate tooth–
supported crowns: A systematic review. Report of the Committee on Research in Fixed Prosthodontics of the
American Academy of Fixed Prosthodontics. Maroulakos G, Thompson GA, Kontogiorgos ED. J Prosthet Dent
2019;121:754-65.
5. M. N. Aboushelib, C. J. Kleverlaan, and A. J. Feilzer, “Selective infiltration-etching technique for a strong and
durable bond of resin cements to zirconia-based materials,” Journal of Prosthetic Dentistry, vol. 98, no. 5, pp.
379–388, 2007.
6. Amorim et al . the surface treatment of dental ceramics: an overview. journal of research in dentistry 2018,
6(4):80-85
7. Connor C et al. Predictable bonding of adhesive indirect restorations: factors for success. British Dental
Journal 2021; 231(5): 287-293.
8. Rosenstiel, S. F., Land, M. F., & Fujimoto, J. (2006). Contemporary fixed prosthodontics. St. Louis, Mo: Mosby
Elsevier.
9. Youngblood A. A safe and convenient technique for the cementation of fixed partial dentures. JADA 2002;
133(10): 1381-1382.

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 THANK YOU

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