Advanced Cementation Update

Webinar

Advanced Cementation Update

Webinar

WebinarOctober 14th

WebinarOctober 14th

John Nosti, DMDJohn Nosti, DMDwww.clinicalmastery.com

The Why, Where, & When of bite relationships

The Why, Where, & When of bite relationships

david@hornbrook.com

david@hornbrook.com

CementationCementationAdhesion

“total-etch”, resin cementSemi-adhesion

Self-etching resin cementNon-adhesion

Glass Ionomer, resinionomer, zinc phosphate, polycarboxylate

Adhesion“total-etch”, resin cement

Semi-adhesionSelf-etching resin cement

Non-adhesionGlass Ionomer,

resinionomer, zinc phosphate, polycarboxylate

Cement Requirements

Cement RequirementsLack of post-operative sensitivity

Strong bond and good seal -to the tooth and to the restorative material

Easy placement and clean-upEsthetics compatible with the restorative material

Minimal film thicknessRadiopaque (posterior)

Lack of post-operative sensitivityStrong bond and good seal -to the tooth and to the restorative material

Easy placement and clean-upEsthetics compatible with the restorative material

Minimal film thicknessRadiopaque (posterior)

Powder liquid ceramic or

Pressed ceramic restorations

Powder liquid ceramic or

Pressed ceramic restorations

“Total-etch”with

Resin Cement

“Total-etch”with

Resin Cement

“Tack & Wave”

Cementation

“Tack & Wave”

CementationVeneers and anterior crownsVeneers and anterior crowns

Emprethin evaluationEmprethin evaluation

Be Careful!!!Be Careful!!!0.2 mm glass is fragile!0.2 mm glass is fragile!

OptraGate (Ivoclar)OptraGate (Ivoclar)

Hydrogen Peroxide in Ultradent SyringeHydrogen Peroxide in Ultradent Syringe

Metal strip removes any interproximal Luxatemp and

freshens the enamel

Metal strip removes any interproximal Luxatemp and

freshens the enamel

Try in independently

DRY

Try in independently

DRY

Occlude Spray Powder (Pascal)Occlude Spray Powder (Pascal)

Try-in collectively DRY!Try-in collectively DRY!

Check complete seatingProximal contacts

Check complete seatingProximal contacts

Dry Erase Marker Dry Erase Marker

Mesial SurfaceMesial Surface

Distal

Surface

Distal

Surface

Variolink Veneer(Ivoclar/Vivadent)

Variolink Veneer(Ivoclar/Vivadent)

Value based0+1, +2, +3-1, -2, -3Microfill

Value based0+1, +2, +3-1, -2, -3Microfill

00 +2+2

Clean and acidify with 35% Phosphoric acidClean and acidify with 35% Phosphoric acid

Silane Coupling Agent (Relyx Ceramic primer) placed for 1 minuteSilane Coupling Agent (Relyx Ceramic primer) placed for 1 minute

Place bonding agent (All Bond 3) inside dry restorationPlace bonding agent (All Bond 3) inside dry restoration

Load restoration with resin cementLoad restoration with resin cement

Vivapad (Ivoclar)Vivapad (Ivoclar)

Etch with 35% phosphoric acid for 15 seconds per toothEtch with 35% phosphoric acid for 15 seconds per tooth

Apply Systemp desensitizer for 15 secondsApply Systemp desensitizer for 15 seconds

Effect of Remoistening

Water-blotted dry 22.8

Water- wet 19.2

Gluma Desensitizer 22.3

HurriSeal 20.1

Vivadent Desensitizer 25.8

MicroPrime 20.1

Aqua-Prep 18.1

Product Dentinal Bond

Water vs. Desensitizer/Rewetting

Agent

“suction” away excess; do not desiccate“suction” away excess; do not desiccate

Apply 2 coats of All Bond 3 A & B Primer mixApply 2 coats of All Bond 3 A & B Primer mix

Adec Warm Air Tooth DryerAdec Warm Air Tooth Dryer

Seat all restorations at one time; do not remove excess resin cement

Seat all restorations at one time; do not remove excess resin cement

Polymerize “dead center” each restoration for 1 second using a

2.0 mm light guide (Ivoclar)

Polymerize “dead center” each restoration for 1 second using a

2.0 mm light guide (Ivoclar)

Hold light guide 1 inch from restorations and light cure 3-5 seconds on facial and lingual

Hold light guide 1 inch from restorations and light cure 3-5 seconds on facial and lingual

General GuidelinesGeneral

Guidelines+2: 5 seconds0: 3 seconds-3: 5 seconds +

+2: 5 seconds0: 3 seconds-3: 5 seconds +

“Pick" away excess using Bard Parker or scaler“Pick" away excess using Bard Parker or scaler

Floss through contacts using a Brasseler Serrated SawFloss through contacts using a Brasseler Serrated Saw

Floss through contacts using waxed dental flossFloss through contacts using waxed dental floss

Place DeOx (Ultradent) on all marginsPlace DeOx (Ultradent) on all margins

Light polymerize for at least 60 seconds per tooth from both buccal and lingual

Light polymerize for at least 60 seconds per tooth from both buccal and lingual

Curing LightsCuring Lights

PhotoinitiatorsCamphoroquinone- 470-490 nm

PhenylDipropandione- 430 nm

PhotoinitiatorsCamphoroquinone- 470-490 nm

PhenylDipropandione- 430 nm

0

10

20

30

40

300 350 400 450 500 600

CQ

CQ 488 nm PDP 430 nm

Wavelength (nm)

OptiLux 501(Demetron)OptiLux 501(Demetron)

Emits light with wavelength 390-510 nm

0

10

20

30

40

300 350 400 450 500 600

CQ

CQ 488 nm PDP 430 nm

Wavelength (nm)

LED Lighti.e.. Freelight (3M), LEDemetron (Kerr),,BluPhase (Ivoclar), DEMI (Kerr)…

LED Lighti.e.. Freelight (3M), LEDemetron (Kerr),,BluPhase (Ivoclar), DEMI (Kerr)…

-No bulb degradation

-Portable

-Wavelength output 450-500 nm

-No bulb degradation

-Portable

-Wavelength output 450-500 nm

0

10

20

30

40

300 350 400 450 500 600

CQ

CQ 468 nm PDP 430 nm

Wavelength (nm)

BluePhase G2(Ivoclar)

BluePhase G2(Ivoclar)

Emits light with wavelength 390-510 nm

Fusionwww.dentlight.com

Remove excess resin cement with Scaler, #12 & #15 Bard-parker Blades

Remove excess resin cement with Scaler, #12 & #15 Bard-parker Blades

Run Serrated Saw through contactsRun Serrated Saw through contacts

1954N Strip (3M)1954N Strip (3M)

Epitex Strips (GC)Epitex Strips (GC)

15 micron finishing diamond (Brasseler))15 micron finishing diamond (Brasseler))

15 micron football-shaped diamond on lingual15 micron football-shaped diamond on lingual

OptraFine Porcelain polishing system (Ivoclar)OptraFine Porcelain polishing system (Ivoclar)

DiaShine ( V & H )DiaShine ( V & H )

Solid Model ContactsSolid Model Contacts

Adhesion to the restoration

Adhesion to the restoration

Ceramist etches in labClinician cleans internal

surfaces with phosphoric acidRinse and dry thoroughlyApply Silane coupling agentApply dual-cure adhesive

resin to internal of restoration

Ceramist etches in labClinician cleans internal

surfaces with phosphoric acidRinse and dry thoroughlyApply Silane coupling agentApply dual-cure adhesive

resin to internal of restoration

Adhesion to the restoration

Adhesion to the restoration

Ceramist etches in labClinician cleans internal

surfaces with phosphoric acidRinse and dry thoroughlyApply Silane coupling agentApply dual-cure adhesive

resin to internal of restoration

Ceramist etches in labClinician cleans internal

surfaces with phosphoric acidRinse and dry thoroughlyApply Silane coupling agentApply dual-cure adhesive

resin to internal of restoration

Blot Dry dentinBlot Dry dentin

Apply primerApply primer

Air dry primerAir dry primer

Light polymerize for 10 secondsLight polymerize for 10 seconds

PosteriorRelyX ARC (3M)PosteriorRelyX ARC (3M)

Hold passively for 3 minutesHold passively for 3 minutes

Remove excess with scaler or explorer

Remove excess with scaler or explorer

Floss through contactsFloss through contacts

Cover margins with oxygen-inhibiting medium

Cover margins with oxygen-inhibiting medium

Light polymerize for at least 60 seconds

Light polymerize for at least 60 seconds

Use scaler and/or #12 Bard Parker

Use scaler and/or #12 Bard Parker

Core-reinforced RestorationsZirconiaAluminaMetal

Lithium disilicate (e.Max)

Core-reinforced RestorationsZirconiaAluminaMetal

Lithium disilicate (e.Max)

Pressed Ceramic/Powder-liquid ceramics

Pressed Ceramic/Powder-liquid ceramics

“Total-etch” resin

cements

“Core” reinforced ceramic(Metal, zirconium, lithium disilicate, alumina oxide)

“Core” reinforced ceramic(Metal, zirconium, lithium disilicate, alumina oxide)

Conventional cements No etch Adhesive cements

High technique sensitivityHigh technique sensitivity

e.Max PressedLithium disilicate pressed

“Core” reinforced ceramic(Metal, zirconium, lithium disilicate, alumina oxide)

“Core” reinforced ceramic(Metal, zirconium, lithium disilicate, alumina oxide)

No etch Adhesive cements(Resin-ionomers, self-adhesive resin

cements)

Conventional cements(Zinc phosphate, polycarboxylate,

Glass ionomer)

“Core” reinforced ceramic(Metal, zirconium, lithium disilicate, alumina oxide)

“Core” reinforced ceramic(Metal, zirconium, lithium disilicate, alumina oxide)

Self-adhesive resin cements(Unicem, MaxCem, Multilink Automix, Panavia FL)

Resin Modified glass ionomers (FujiCem, FujiPlus, RelyX Luting)

No etch adhesive cements

“Self-adhesive” resin cements(the benefits of resin without the technique sensitivity)

“Self-adhesive” resin cements(the benefits of resin without the technique sensitivity)

Single component Self-Adhesive(Unicem, MaxCem, others)

Assisted Self-adhesive resin cements(Multilink Automix, Panavia FL)

“Single Component Self-adhesive “ cements“Single Component Self-adhesive “ cements

Embrace

Unicem (3M)MaxCem Elite (Kerr)Embrace Wetbond ( Pulpdent)

G-Cem (GC)BisCem (Bisco)

Unicem (3M)MaxCem Elite (Kerr)Embrace Wetbond ( Pulpdent)

G-Cem (GC)BisCem (Bisco)

“Single Component Self-adhesive “ cements“Single Component Self-adhesive “ cements

EmbraceBisCem (Bisco)

“Single Component Self-adhesive “ cements“Single Component Self-adhesive “ cements

Embrace

Bond strengths (Reality)

Dentin EnamelMaxCem 3.8 8.8

Unicem 7.7 16.6

BisCem 9.0 15.0

“Total-etch” 30.3 25.4 Relyx

Advantages of “Single Component self-adhesive” cements

Advantages of “Single Component self-adhesive” cements

Good physical properties Some adhesive properties

Very, very easy to use

Disadvantages of “Single Component self-adhesive” cements

Disadvantages of “Single Component self-adhesive” cements

Mediocre bonds to dentin and enamel

Questionable long term enamel bonds

Questionable bonds to restorative substrate

Assisted “Self-etch” resin cementsAssisted “Self-etch” resin cements

Panavia FL2.0(Kuraray)

Bistite II DC(J. Morita)

Multilink Automix(Ivoclar)

Advantages of Assisted “Self-adhesive” cements

Advantages of Assisted “Self-adhesive” cements

Good physical properties Good adhesive properties

Easier to use than “Total-etch” cements

Assisted “Self adhesive” cementsAssisted “Self adhesive” cements

Embrace

Bond strengths (Reality)

Dentin EnamelPanavia F 2.0 7.6 11.5

Bistite II 14.7 12.7

Multilink 15.1 16.4

“Total-etch” 30.3 25.4 Relyx

Involves an adhesive stepBonds not as strong as

“Total-etch”

Disadvantages of Assisted “Self-adhesive” cements

Disadvantages of Assisted “Self-adhesive” cements

Can we “etch “with phosphoric acid with self-etch cements?

Can we “etch “with phosphoric acid with self-etch cements?

Decreased bond strengths to dentin

Total-etch Self-etchPanavia F 2.0 18.3 11.8Unicem 16.6 8.5

Multilink 21.2 16.4

BisCem 15.0 13.8

Enamel Bonds

When do I use what?

When do I use what?Non-core supported ceramic:

“Total etch”Core-supported Ceramic

Minimal retention and resistance form?“Total-etch” with dual cure resin cement

Adequate retention and resistance?“self-adhesive” resin cements

Non-core supported ceramic:“Total etch”

Core-supported CeramicMinimal retention and resistance form?“Total-etch” with dual cure resin cement

Adequate retention and resistance?“self-adhesive” resin cements

Hornbrook 2009 Updates –

Full Day Events

Hornbrook 2009 Updates –

Full Day Events

November 6th – Albuquerque, NMNovember 13th – Boston, MA at Tufts University

Topics include:•2009 Materials Update•My top 10 failures and how YOU can avoid them! •Treatment Planning the Full Mouth Rehabilitation •Winning Case Presentation Techniques for a Tough Economy •Prepless Veneers: Necessary Addition to Your Restorative Arsenal •And much more!