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DENTAL CEMENTS

Presented by;
Snehal Sonarkar
Department of conservative dentistry
and endodontics

Terna Dental College.


Nerul, Navi Mumbai.

Content;
Introduction
History
Ideal properties of dental cements
Classification of cements

RDT & Pulpal response


Pulp protecting agents
Cavity varnish
Calcium hydroxide
Zinc oxide eugenol cement

Fluoride releasing cements


Silicate cement
Zinc silicophosphate cement
Glass ionomer cement

Luting agents
Zinc phosphate cement
Zinc polycarboxylate cement
Resin cements

Miscellaneous
Mineral Trioxide Aggregate
Biodentine
I Root BP

Properties of cements
Conclusion
References

Introduction
Variety of cements are used for various purpose.
Different applications make varying demands on
Manipulative properties.
working and setting time.
resistance to mechanical breakdown and

dissolution.

Materials are supplied


powder/liquid form and set by acid-base reaction,

but this is not universally true.

So, in dentistry word cement has been applied,

traditionally to powder/ liquid materials which are


mixed to a paste consistency set to a hardness,
and used clinically to restore teeth and attach
preformed restorations, in or on the teeth.

History
Period of mechanical improvement
AD 1050 to 1122 - according to the Arabian

author Rhazes.
Carious teeth were filled with ground mastic, alum,

and honey or other substances.

Riviere (1589) mentioned Oil of cloves (eugenol)


applicable to dental operations, but may have been

used earlier (1562) by Ambroise Pare to alleviate


toothache.
Craigs Restorative dental materials. 12th ed

1860 Zinc oxychloride (filling and cementing

medium).
1879 Zinc phosphate was introduced
1908 Silicate cement was introduced in US.
Cruder

forms were used in europe in late 1800.

1947 direct filling methyl methacrylate

Journal of History of Dentistry 2005;July, 53(2):63-72.

1960-70s Pit & fissure sealant introduced.


1970s - polycarboxylate
1971 Wilson & kent introduced GIC.
1993- Torabinejad introduced MTA
2008 Prof. Abbot introduced Biodentine.

Definition
Cement
Substance that hardens to act as a base, liner, filling material,

or adhesive to bind devices and prostheses to tooth structure


or to each other. (Phillips)

A non metallic material used for luting, filling permanent or

temporary restorative purposes, made by mixing components


into a plastic mass that sets or as an adherent sealer in
attaching various dental restorations in or on the tooth. (Craig)

Ideal Properties of DENTAL CEMENTS


1. Well adapted to living dental tissues
2. Non- toxic and non-irritant

3. Anticariogenic qualities
4. Low viscosity and film thickness reach areas

between restoration and tooth.


5. Resistant against mastication forces and pulling

forces formed through the effect of gummy foods

Contemporary Permanent Luting Agents Used in Dentistry: A Literature Review


Ebru SMER, Yaln DEER(Int Dent Res 2011;1:26-31)

6. Mechanical properties meet the requirements for


particular application.
7. Sufficient light transparency.
8. Heat insulation to protect living tooth from thermal
effects.
9. sufficient working time and be easy to manipulate.
10. Bond to hard dental tissues.
Contemporary Permanent Luting Agents Used in Dentistry: A Literature
Review Ebru SMER, Yaln DEER(Int Dent Res 2011;1:26-31)

11. Long shelf-life.


12. Antibacterial property
13. Biocompatible.
14. Chemically compatible with pulp and restorative material.
15. Should not discolor tooth and restorative material.
16. Should stabilize or diminish dentin permeability.

Operative Dentistry: Modern theory and practice. MA Marzouk. 2004

CLASSIFICATION

Classification..

According to Phillips
Fluoride-Releasing
Cements for DirectFilling Restorations

Cements as Luting
Agents

Agents for Pulp


Protection

Silicate

Zinc phopshate

Cavity varnishes

Zinc Silicophosphate ZOE

Cavity liners

Glass ionomer

Cement bases

Zinc polycarboxylate
Glass ionomer
Resin- modified glass
ionomer
Compomer
Resin cements

Phillips Science of dental material. 11th ed. 2002

Classification..

According to reaction
Acid Base Reaction

Light / Chemical

Light / Chemical

activated

activated

polymerization and

polymerization

acid base reaction

Zinc Phosphate cement

Resin modified glass

Compomers

Zinc polycarboxylate

ionomer cement

Resin cement.

cement
Zinc oxide- eugenol
cement
Glass ionomer
Phillipscement
Science of dental material. 11th ed. 2002

Classification..

According to ingredients & application By Craig


Water based cements

Application

Glass and resin

Class 5 restorations

modified glass

Retention of alloy restorations

ionomer cement

Retention of alumina or zirconia based all


ceramic restoration
Retention of orthodontic bands
Provisional restorations

Zinc Polyacrylate

Retention of alloy restorations


Retention of orthodontic bands
Retention of pediatric stainless steel crown

Zinc phosphate

Retention of conventional restorations


Retention of orthodontic bands
Provisional restorations

Craigs Restorative dental material. 12th ed. 2006

Classification..
Resin-Based cements

Application

Composites and

Bonded conventional crowns and bridges,

Adhesive resins

veneers, inlays, and onlays


Bonded laboratory composites crowns and
bridges, veneers, inlays, and onlays.
Bonded posts and cores.
Retention of provisional restorations
Retention of orthodontics bands

Compomers

Bonded conventional alloy based restoration


Retention of alumina or zirconia-based all
ceramic restoration.
Retention of orthodontic brackets
High-strength bases

Craigs Restorative dental material. 12th ed. 2006

Classification..

Oil-based cements

Application

Zinc Oxide eugenol

High-strength bases
Provisional restorations
Root canal sealers
Gingival tissue packs
Surgical dressings

Noneugenol-Zinc oxide

Provisional restorations
Root canal sealers
Gingival tissue packs
Surgical dressings

Craigs Restorative dental material. 12th ed. 2006

Classification..

According to OBrien
OBrien classified dental cements by matrix bond type

OBrien Dental material and their selection. 3rd ed. 2003

Classification..

Type of
matrix
bond

Class of cement

Phosphate Zinc phosphate

Formulation

Zinc
Zinc
Zinc
Zinc

phosphate
phosphate fluoride
phosphate copper oxide/salts
phosphate silver salts

Zinc silico-phosphate Zinc silicophosphate


Zinc silicophosphate mercury salts
Phenolate

Zinc oxide-eugenol

Zinc oxide-eugenol
Zinc oxide-eugenol polymer
Zinc oxide-eugenol EBA/alumina

Calcium hydroxide
salicylate

Calcium hydroxide salicylate

OBrien Dental material and their selection. 3rd ed. 2003

Classification..

Type of matrix
bond

Class of
cement

Polycarboxylate

Zinc
Zinc polycarboxylate
polycarboxylate Zinc polycarboxylate fluoride

Dimethacrylate

Formulation

Glass ionomer

Calcium aluminum polyalkenoate


Calcium aluminum polyalkenoate
polymethacrylate

Acrylic Poly
(methyl
methacrylate)

Dimethacrylate unfilled
Dimethacrylate filled

Adhesive

4-META

Polycarboxylate
Hybrid
& Dimethacrylate ionomers

Self cured Light cured

OBrien Dental material and their selection. 3rd ed. 2003

Classification..

According to Sturdevants
Traditional
ceramic
dental
cement

Abbrevi
ations

Liquid
compon
ent

Powder
component

Reaction product matrix

Unmodified
ZOE

ZOE

Eugenol

ZnO

Crystalline zinc eugenolate

Resin
reinforced ZOE

R-ZOE

Eugenol

ZnO, polymer, Crystalline zinc eugenolate


resin

EBA- modified
ZOE

ZOE-EBA

Eugenol,
EBA

ZnO, Al2O3,
polymer

Crystalline zinc eugenolate


Crystalline zinc
ethoxybenzoate

Zinc phosphate

ZP

H3PO4,
H2O

ZnO

Crystalline tertiary zinc


phosphate

Silicate

SC

H3PO4,
H2O

F-Al-Silicate
glass

Amorphous silico phosphate

Zinc
silicophosphate

ZSP

H3PO4,
H2O

F-Al-Silicate
glass, ZnO

Amorphous silico phosphate


Crystalline tertiary zinc
phosphate

Sturdevants Art and Science of dental materials. 5th ed. 2006

Polymer
based
dental
cement

Abbr Liquid
eviati compone
ons
nt

Powder
compone
nt

Reaction product matrix

Polycarboxyl
ate

PC

PAA, H2O

ZnO

Amorphous zinc
polyacrylate gel

Conventional GI
GI

PAA, H2O

F-AlSilicate
glass

Amorphous
aluminopolyacrylate gel

Resin
modified GI

RMGI

PAA, H2O,
water
soluble
monomers

F-AlSilicate
glass

Amorphous
aluminopolyacrylate gel,
cross linked polymer

Compomer

CM

Monomers

F-AlSilicate
glass

Amorphous cross linked


polymer,
aluminolpolyacrylate gel

Composite
(or resin)

CP

Monomers

Silicate
glass

Amorphous cross linked


polymer

Sturdevants Art and Science of dental materials. 5th ed. 2006

Classification..

Donovan classified as;


Conventional
Zinc phosphate,
Polycarboxylate,
Glass Ionomer

Contemporary
Resin-modified glass ionomers,
Resin based

Donovan TE, Cho GC. Contemporary evaluation of dental cements. Compend


Contin Educ Dent 1999;20(3):197219. taken from
Dental Cements for Definitive Luting: A Review and Practical Clinical
Considerations. Edward E. Hill, Dent Clin N Am 51 (2007) 643658

According to function
Function

Cements

Final cementation of
completed restorations

Zinc phosphate, Zinc Silicophosphate,


reinforced ZOE, Zinc polycarboxylate,
Glass ionomer

Temporary cementation of
completed restorations or
cementation of temporary
restoration

ZOE, noneugenol ZO

High strength bases

Zinc phosphate, reinforced ZOE, Zinc


Polycarboxylate, Glass ionomer

Temporary fillings

Zinc phosphate, reinforced ZOE, Zinc


Polycarboxylate

Low strength bases

ZOE, Calcium hydroxide

Liners

Calcium hydroxide in suspension

Varnishes

Resin in solvent

Classification of intermediary bases


Varnishes
A solution of natural gum, synthetic resins, or rosins

dissolved in a volatile solvent, such as acetone, ether, or


chloroform. (Phillips)
Liner
Thin layer of cement, such as a calcium hydroxide suspension in an

aqueous or resin carrier (after evaporation), used for protection of


the pulp; certain glass ionomer cements that are used as an
intermediate layer between tooth structure and composite
restorative material are also considered liners. (Phillips)
Operative Dentistry: Modern theory and practice. MA Marzouk. 2004

Subbases
Therapeutic material placed in deep portions of

cavity
Posses specific pharmacological action.

Base
A layer of insulating, sometimes medicated, cement

placed in deep portion of the preparation to protect pulpal


tissue from thermal and chemical injury.

Operative Dentistry: Modern theory and practice. MA Marzouk. 2004

Function of base
The function of the cement base is to promote recovery

of the injured pulp and to protect it against further


insult.
The base serves as a thermal insulator and replaces

missing dentin when it is used under the metallic


restoration.
Galvanic shock and chemical irritation.
Resist fracture under masticatory loads.

Dentistry for the Child and Adolescent. RALPH E. McDONALD. 8th ed.
Phillips Science Of Dental Materials. 11th ed.

Pulp protection
Chemical protection
Electrical protection
Thermal protection
Pulpal medication

Schematic view of need for pulpal


protection.(Sturdevant 5th ed)

Mechanical protection

Sturdevants Art and Science of dental materials. 5th ed. 2006

Schematic examples of use of liners and bases for amalgam restoration.


A Shallow amalgam tooth preparation, varnish or sealer applied to
walls.
B Moderate depth tooth preparation liners may be placed for thermal
protection and pulpal medication
C deep preparation light cured calcium hydroxide is placed in deepest
region in which infected dentin was excavated. Base- glass
ionomer.
Sturdevants Art and Science of dental materials. 5th ed. 2006

Remaining dentin thickness


Importance of maximizing the RDT beneath cavity

preparations in reducing pulpal damage has long


been established.

Preserving the Vital Pulp in Operative Dentistry: 3. Thickness of Remaining


cavity Dentine as a Key Mediator of Pulpal Injury and Repair Responses.
PETER E. MURRAY, PHILIP J. LUMLEY AND ANTHONY J. SMITH. Dental Update
May 2002

Pulp protecting agents..

Minimal cavity RDT that does not cause unequivocal

pulp injury have been decreasing:


Stanley (1984) - RDT of 2 mm.

Pameijer, Stanley and Ecker (1991) RDT of 1 mm or

more would protect the pulp tissue from the cytotoxic


effects of luting process

Preserving the Vital Pulp in Operative Dentistry: 3. Thickness of Remaining


cavity Dentine as a Key Mediator of Pulpal Injury and Repair Responses.
PETER E. MURRAY, PHILIP J. LUMLEY AND ANTHONY J. SMITH. Dental Update
May 2002

Pulp protecting agents..

RDT <0.3 mm persistent pulp inflammation

(pulpitis)
Studies RDTs between 0.25 mm and 0.50 mm.

Preserving the Vital Pulp in Operative Dentistry: 3. Thickness of Remaining


cavity Dentine as a Key Mediator of Pulpal Injury and Repair Responses.
PETER E. MURRAY, PHILIP J. LUMLEY AND ANTHONY J. SMITH. Dental Update
May 2002

Pulp protecting agents..

Ability materials tested to maintain odontoblast

survival with RDT below 0.5 mm was as follows:


calcium hydroxide 100%;
polycarboxylate 81.1%;
zinc oxide eugenol 78.4%;
composite resin 74.2%;
enamel-bonded resin 48.3%;
resin-modified glass ionomer 43.1%.
Preserving the Vital Pulp in Operative Dentistry: 3. Thickness of Remaining
cavity Dentine as a Key Mediator of Pulpal Injury and Repair Responses.
PETER E. MURRAY, PHILIP J. LUMLEY AND ANTHONY J. SMITH. Dental Update
May 2002

Pulp protecting agents..

Mechanisms to stimulate formation of reactionary dentin:


cavity preparation trauma;
restorative dental procedures;
operator hand instrumentation;
pathogenic diseases;
caries;
attrition;
erosion;
chemicals;
restorative materials; and
bacterial microleakage.

Dental Update May 2002

Pulp protecting agents..

The rank order of reactionary dentine secreted in

preparations with an RDT below 0.5 mm was:


calcium hydroxide;
composite resin;
resin-modified glass ionomers;
zinc oxide eugenol;
polycarboxylate.

Dental Update May 2002

Pulp protecting agents..

Light micrograph of a dentin

bridge that has formed between


a material and the pulp in a
monkey.

Craigs Restorative dental materials. 13th ed

Pulp protecting agents..

Initially, the pulp of the tooth was purposely exposed (top right)

with a bur.
The exposure was covered with a calcium hydroxide pulp-capping

agent for 5 weeks before histological evaluation.


A layer of secondary dentin has formed at the site of the pulp

exposure, forming a dentin bridge.


Some inflammatory cells are evident under the bridge, but the

pulpal response is generally favourable.

Remaining dentin thickness calculation

Effective depth in radiograph


enamel thickness in radiograph

Actual effective depth =

actual effective depth


actual enamel thickness

Effective depth in radiograph x actual


enamel thickness
Enamel thickness in radiograph.

Operative Dentistry: Modern theory and practice. MA Marzouk. 2004

Other methods for calculation of RDT


Ultrasonic pulse-echo techniques may allow for such a

determination of RDT.

A Plastic delay line, B retaining sleev, C- Ultrosonic transducer,


D electrical connector
In Vitro and In Vivo Measurement of Remaining Dentin Thickness. Hatton JF,
Pashley DH, Shunk J, Stewart GP. J Endod;1994:20;12:580-84

Pulp protecting agents

Pulp protecting agents


Cavity varnish
Calcium hydroxide
Zinc oxide eugenol cement

Pulp protecting agents..

Agents for pulp protection


Metallic restorations, which are excellent thermal

conductors thermal sensitivity during drinking of


hot and cold foods or beverages
Cavity varnishes, liners, and bases are used as

adjuncts.

Phillips Science Of Dental Materials. 11thed.

Pulp protection procedure


(Medicament/liner/ sealer)

Material

Shallow
excavation (RDT
>2mm)

Moderate
Deep
excavation
Excavation
(RDT 0.5-2mm) (RDT<0.5mm)

Amalgam

No/no/sealer

No/base/ sealer

CH/base/sealer

Composite

No/no/DBS

No/no/DBS

CH/no/DBS

Gold inlays
and onlays

No/no/cement

No/base/cement

CH/base/cement

Ceramic

No/no/DBS, CC

No/no/DBS, CC

CH/no/DBS, CC

Sealer GLUMA. Base vitrebond cement RMGI


CC composite cement. CH dycal liner. DBS dentin bonding system.
Sturdevants Art and Science of dental materials. 5th ed. 2006

Pulp protecting agents..

Cavity varnish
Definition;
A solution of natural gum, synthetic resins, or rosins dissolved

in a volatile solvent, such as acetone, ether, or chloroform.


(Phillips)
A cavity varnish is used to provide a barrier against the

passage of irritants from cements or other restorative


materials and to reduce the penetration of oral fluids at the
restoration-tooth interface into the underlying dentin. (Craigs)
Phillips Science of Dental material 11th ed 2003
Craigs Restorative dental materials. 12th ed

Composition;

Resins

Medicinal agents
Volatile solvents

natural gums, synthetic


resins, or rosin.
(Copal and nitrated
cellulose natural gum
and synthetic resin).
chlorobutanol, thymol,
and eugenol
evaporate quickly
leaving a thin resin film.

Craigs Restorative dental materials. 12th ed

Liners
Solution liners varnishes 2-5m

Thin layer 2-5 m is formed

Suspension liners 20-25 m

Thick layer 20-25 m

Sturdevants Art and Science of dental materials. 5th ed. 2006

Pulp protecting agents..

Applied thin consistency


Using brush or a small pledget of cotton or sable

hair brush.
Disposable applicator be used and discarded
Solvent loss occurs 8-10sec (Sturdevants)

Phillips Science Of Dental Materials. 11th ed.

Small cotton pledget


formed by few fibres bent
over on themselves.

Small cotton applicator prepared on


long handled endodontic file or reamer
bent in angle.

Principles and practice of operative dentistry. Charbeneau. 2nd ed.1981.

First layer dries small pinholes usually develop.


55% of surface is covered (Sturdevants)

A second or third application fills in most of

these voids.
80-85% of surface is covered. (Sturdevants)

Copalite varnish partially occluding dentinal tubule

SEM two layer of varnish

SEM one layer of varnish

Sturdevants Art and Science of dental materials. 5th ed. 2006

Pulp protecting agents..

Application
Dentinal surfaces to minimize the penetration of acid from zinc

phosphate cements.
Enamel and dentinal walls to reduce the penetration of oral fluids

around metallic restorations.


Retard penetration discolored corrosion products from dental

amalgam into dentin.


Cavity varnish is applied to the dentinal walls of those tubules in

direct contact with the pulp when a base of zinc phosphate cement.
Craigs Restorative dental materials. 12th ed

Pulp protecting agents..

When therapeutic action is expected;


Action - Base or liner

material

Then, cavity varnish is not used on the

underlying dentin.
Varnish - applied over the cement base.

Craigs Restorative dental materials. 12th ed

Pulp protecting agents..

Contraindication
Not used under composite restoration

Bonding agents effectively seal dentinal tubules.

Cavity Liners

Pulp protecting agents..

Definition;
Thin layer of cement, such as a calcium hydroxide suspension in

an aqueous or resin carrier (after evaporation), used for protection


of the pulp; certain glass ionomer cements that are used as an
intermediate layer between tooth structure and composite
restorative material are also considered liners. (Phillips)

Also referred as;


Intermediary bases
Pulp-Capping agents

Phillips Science Of Dental Materials. 11th ed.

Functions
Accelerates formation of reparative dentin.
Adhesion at tooth restoration interface.
Sealing dentin from influx of microorganism and

irritants.

Phillips Science Of Dental Materials. 11th ed.

Pulp protecting agents..

Materials used;

Calcium hydroxide
Hermann in 1920.
Properties
Antibacterial, antiseptic
Intracanal medicament

Cohens Pathways of Pulp. 10th ed. pg254

Pulp protecting agents..

Ca(OH)2 mixed with sterile water or saline.


Commercially available as;
Calcium hydroxide
Dycal (Dentsply Caulk, Milford,DE, USA)

Cohens Pathways of Pulp. 10th ed. pg254

Pulp protecting agents..

Base

Catalyst

Disalicylate (ester of 1,3, butylene glycol) Calcium hydroxide


Calcium phosphate
Ethyl toluenesulfonamide
Calcium tungstate
Zinc sterate
Zinc oxide
Titanium dioxide
Iron oxide
Zinc oxide
Iron oxide

www.dentsplymea.com

Pulp protecting agents..

Indication
Application to exposed, vital pulp tissue (direct pulp

capping).
Protective barrier between restorative materials and deep

vital dentin (indirect pulp capping)

www.dentsply.com

Manipulation

Pulp protecting agents..

Dry cavity preparation


Dispense equal volumes of base and catalyst pastes on paper

pad provided.
Thoroughly mixed until a uniform color is achieved.
Mixing ratio Base and catalyst- 1.17gm:1gm
Mixing time -10 seconds.

www.dentsply.com

Place the mix on the exposed pulp and cavity dentin judged

to be less than 1.0mm remaining thickness in a thin layer.


Material thickness - 0.8mm-1mm.
Working time 2min 20seconds
Setting time- 2-3 minute
shorter in the mouth due to moisture and temperature.

www.dentsply.com

Biological property
It can be irritant to pulp.
Depth an effective biological reaction;
100m < healthy reparative reaction.
100m > unhealthy reparative reaction.
Direct contact with pulp chemical necrosis.

Operative Dentistry: Modern theory and practice. MA Marzouk. 2004

Light cured calcium hydroxide


Prisma VLC Dycal - Dentsply Caulk

COMPOSITION
Calcium Hydroxide;
Barium Sulfate;
Urethane Dimethacrylate Resin;
photoinitiator;
stabilizer;
pigments

www.dentsplymea.com

INDICATIONS
Direct pulp capping
Protective barrier between restorative materials and

deep vital dentin (indirect pulp capping).

CONTRAINDICATIONS
Patients who have a history of severe allergic reaction to
methacrylate resins.

www.dentsplymea.com

STEP-BY-STEP DIRECTIONS
Direct Pulp Capping
complete cavity preparation
Rinse the cavity and exposure site
Gently dry preparation with cotton pellet. Avoid

desiccation.
Liner directly on the exposed pulp and cavity dentin

judged to be less than 1mm remaining thickness in


a thin layer.

www.dentsplymea.com

Material thickness should be approximately 0.8mm-1mm.


Light cure spectral output containing 470 nm.
Minimum light output must be at least 300mW/cm2

exposure for at least 20 seconds.


Remove any material excess from retention areas,

enamel, and/or margins with a sharp spoon excavator or


a bur.
Pulp vitality assessed in next appointment

www.dentsplymea.com

Pulp protecting agents..

Properties of liners

Calcium hydroxide

ZnO cements

Lining deep cavities/ Direct


pulp capping

In deep cavities to retard


penetration of acids and reduce
discomfort to pulp

Antibacterial action

Zinc Oxide and Eugenol based


Formulated as;
Powder and liquid
Two paste system

Craigs. Restorative Dental Material. 12th ed

Indication
Temporary cement
Thermal insulating base
Root canal filling

COMPOSITION
Powder

Function
Gm
(Phillips
7th ed)

Weight(%)
(Craig
12th ed)

Zinc oxide

70gm

69

Principal ingredient

Rosin

28.5

29.3

Reduce brittleness of set


cement

Zinc
stearate

Plasticizer

Zinc
acetate

0.5

0.7

Improve strength of set


cement

Skinners Science of dental materials. 7th ed.


Craigs restorative dental material. 12th ed

Liquid

Eugenol
Olive oil

(Phillips
7th ed)

(Craig
12th
ed)

Function

85

85

Eugenol with olive oil


act as plasticizer.

15

Formulation and uses by ADA specification no. 30


Types

Uses

Type I

Temporary cementation

Type II

Permanent cementation

Type III

Temporary filling material and


thermal insulating base

Type IV

Cavity liners
Phillips Science Of Dental Materials. 11th ed.

Powder
Zinc hydroxide Zinc carbonate
300C

Zinc oxide
Carbonate
300- 500C

Magnesium oxide
Phillip s science of dental material. 7th ed.

Manipulation of ZOE
Powder - incorporated into dispensed amount of liquid

until a suitable consistency is achieved for the


operation.
Considerable amount of powder - incorporated into the

liquid by heavy spatulation with a stiff spatula.


More powder - stronger the cement and the more

viscous the mixed cement.

Craigs. Restorative Dental Material. 11th ed

Bulk of powder incorporated in liquid.


P/L 4:1 or 6:1
Initial step,
mix is thoroughly spatulated, and a series of smaller

amounts is then added until the mix is complete.


mix is thoroughly kneaded with the spatula (a stiff bladed

steel spatula is the most effective type).

Craigs. Restorative Dental Material. 11th ed

Setting reaction
Setting chelation reaction zinc

eugenolate.

Craigs. Restorative Dental Material. 12th ed

Setting reaction - accelerated by increases in

temperature or humidity.
EBA also forms a chelate with zinc oxide, and its

presence allows some crystalline zinc eugenolate to


form, which provides additional strength.
Accelerators

Retarders

Water, alcohol, glacial acetic acid

Glycol/ glycerine

Craigs. Restorative Dental Material. 12th ed

Factors affecting setting time


Incorporating chemical accelerators in mix
Reducing particle size.
Increasing P/L.
Increasing percentage of fillers.
Increasing temperature/ humidity.
Adding water to original mix.
Introducing greater energy in mixing procedure.

Operative Dentistry: Modern theory and practice. MA Marzouk. 2004

Specification requiremment of ZOE and ZnO


noneugenol cements

Craigs. Restorative Dental Material. 12th ed

Other properties
Least amount of shrinkage 0.1% by volume.
CTE 11 ppm/C

Biological properties
Least irritating to pulp-dentin organ.
Create impervious layer to elements normally

present in oral environment.


Applied in 0.5mm thickness.
Decreases hardness of very minimal thickness of

underlying dentin
CTE and thermal diffusivity- less then tooth

structure. (0.25)
Operative Dentistry: Modern theory and practice. MA Marzouk. 2004

Bonding to composites
Inhibitory effect of methoxyphenols such as eugenol on the

polymerization of methacrylate resins is of clinical importance.

Eugenol is considered a free-radical scavenger(presence of the allyl

group)
Act as a degradative chain-transfer agent (i.e., when activated, it

preferably undergoes primary radical termination, rather than


propagation).

Temporary cements containing eugenol may negatively affect the

polymerization of methylmethacrylate used in provisional restorations.


Craigs. Restorative Dental Material. 13th ed

Non-eugenol cement
TNE-Temrex Non-Eugenol Temporary

Cement(Temrex)
Dentsply Integrity TemGrip
Non-Eugenol Temporary Cement(Morita)
PowerTemp (kerr dental)

Composition
Integrity TempGrip
Organic acids;
Zinc oxide;
Methacrylates;
Catalyst;
Stabilizer

www.dentsply.es

Indication
Temporary cementation of provisional acrylic and

composite indirect restorations.


Provisional or trial cementation (limited time) of

ceramic, porcelain, composite, PFM (porcelain


fused to metal) and all metal crowns and bridges.

EBA and other chelate cements

Modified ZOE
EBA alumina- modified cements provisional restorations.
Has improved carvability prevented chipping during

trimming
symptomatic teeth without pulp exposure showed no

symptoms.
EBA low solubility in water, disintegrated and wore excessively

in the mouth.

Craigs. Restorative Dental Material. 12th ed

EBA and other chelate cements

Application
These materials have been used
cementation of inlays, crowns, and fixed partial

dentures
for provisional restorations
base or lining materials.

OBrien. Dental material and their selection. 3rd ed.(2002)

EBA and other chelate cements

Composition
Powder

Liquid

Zinc oxide

Ethoxybenzoic acid -

Aluminum oxide or other

50% to 66% with the

mineral fillers-20% to 30% .

remainder eugenol.

Polymeric reinforcing agents poly(methyl


methacrylate), may also be
present

OBrien. Dental material and their selection. 3rd ed.(2002)

EBA and other chelate cements

Setting
The setting mechanism has not been fully elucidated.
It appears to involve chelate salt formation between

the EBA, eugenol, and zinc oxide.


The setting is accelerated by the same factors that are

operative for zinc oxide-eugenol cements.

OBrien. Dental material and their selection. 3rd ed.(2002)

Manipulation
Cement is dispensed according to the

instructions
kneaded for 30 seconds,

and then stropped for

60 seconds to develop a creamy consistency.


Oil of orange can be used to clean eugenol

cements from instruments.

Craigs restorative dental material. 11th ed.

Properties
Setting time ; 7 and 13 minutes.
The EBA cements show viscoelastic properties with very low strength

and large plastic deformation at slow (0.1 mm/min) rates of deformation


and at oral temperature (37C).
Solubility similar to - polymer-reinforced zinc oxide-eugenol materials in

distilled water, although loss of eugenol also occurs.


The resistance to solubility in organic acids appears to be greater than

that of the zinc phosphate cements.


When exposed to moisture, greater oral dissolution occurs than for other

cements.
OBrien. Dental material and their selection. 3rd ed.(2002)

Zinc oxide Film


eugenol
Thickn
ess(m
m)

Setting
time
(min)

Solubility
(wt%)

Compres
sive
(MPa)

Tensile
(MPa)

Modulus
of
elasticity

Unmodified 25-35

2-10

1.5

2-25

1-2

Polymer
reinforced

35-45

7-9

35-55

5-8

2-3

EBAalumina

40-60

7-13

55-70

3-6

3-6

OBrien. Dental material and their selection. 3rd ed.(2002)

Advantages and Disadvantages


Advantages
easy mixing, long working time, good flow characteristics, and

low irritation to pulp.


Strength and film thickness can be comparable to those of zinc

phosphate cements.

Disadvantages
Critical proportioning, hydrolytic breakdown in oral fluids,

liability to plastic deformation, and poorer retention than zinc


phosphate cements.

Resin reinforced ZOE


Used
cementing agents for crowns and fixed partial

dentures
cavity liners and base materials
provisional restorative materials.

OBrien. Dental material and their selection. 3rd ed.(2002)

Powder

Liquid

Zinc oxide- 10% to 40%

Eugenol

natural or

accelerators - acetic

synthetic resins (eg,

acid, antimicrobial

colophony [pine resin],

agents - thymol or 8-

poly[methyl methacrylate],

hydroxyquinoline.

polystyrene,
or polycarbonate) together
with accelerators.

OBrien. Dental material and their selection. 3rd ed.(2002)

Manipulation
More powder is required for a cementing mix than with other

cements.
The mixing pad or slab should be thoroughly dry.
The powder is mixed into the liquid in small portions with vigorous

spatulation until the correct amount has been incorporated.


Adequate time should be allowed for setting without disturbance

of the cement. Both powder and liquid containers should be kept


closed and stored under dry conditions.

OBrien. Dental material and their selection. 3rd ed.(2002)

Properties
Because of the presence of the resin, the

solubility of these cements appears to be


somewhat lower than that of zinc oxide-eugenol
materials.

OBrien. Dental material and their selection. 3rd ed.(2002)

Advantages and Disadvantages


Advantages
Minimal biologic effects, good initial sealing properties, and

adequate strength for final cementation of restorations.

Disadvantages
Lower strength, higher solubility, and higher disintegration

compared to zinc phosphate cements; hydrolytic instability; and


the softening and discoloration of some resin restorative
materials.

OBrien. Dental material and their selection. 3rd ed.(2002)

Fluoride releasing dental


cements
These material have Low strength resin based

composites and amalgam low stress areas.


Temporary and intermediate restorations.

Use of dental cements began with silicate cement.

Phillips Science Of Dental Materials. 11th ed.

Anticariogenic mechanism of fluoride:


Increased acid resistance of enamel
Enhancement of remineralization,
Inhibition of carbohydrate metabolism by the acidogenic

plaque microflora.

Phillips Science Of Dental Materials. 11th ed.

Cements as luting agents


The word luting implies the use of a moldable

substance to seal a space or to cement two


components together.

Phillips Science Of Dental Materials. 11thed.

Microscopic image of the abutment prosthesis interface

A irregular surface

B two surface pressed against


each other

C continuous interface with


third material

D voids generation

Phillips Science Of Dental Materials. 11th ed.

Procedure for luting


Placement of cement
Seating the prosthesis
Removing excess cement.

Placement of cement
Cement paste should coat Inner surface of the crown

and extend slightly over the margin.


The occlusal aspect of the tooth preparation must be

free of voids - to ensure no air entrapment.


If voids remain in the occlusal region excessive

tensile stress in the ceramic and a greater risk for


fracture.

Phillips Science Of Dental Materials. 11th ed.

Seating
Moderate finger pressure - displace excess cement.
Marginal gap evaluated with explorer at three or more

points.
Patient is asked to bite on a piece of cotton roll to ensure

complete seating.

Phillips Science Of Dental Materials. 11th ed.

Removal of excess cement


Brittle state does not adhere to the surrounding

surfaces, the tooth and the prosthesis removed


after it sets.
Zinc phosphate and ZOE cements.

Glass ionomer, zinc polycarboxylate, and resin

cements adhere both chemically and/or physically


surfaces can be coated separating medium to
inhibit cement adherence
Phillips Science Of Dental Materials. 11th ed.

Mechanism of Retention
Retained mechanical or chemical
Cement fills the irregular crevice cement/prosthesis and

cement/tooth exhibit a void-free sealed cement layer can


resist shear stress acting along the interface

Mechanism through which dental


cement provides mechanical retention
of a gold inlay.
Cement penetrates into irregularities in
the tooth structure and the casting.
Phillips Science Of Dental Materials.
11th ed.

Dislodgement of Prosthesis
Fixed prostheses can debond because of biological

factors, physical reasons, or a combination of the two.


Secondary caries forms the biological reason.
Modes of failure;
Fracture of cement
Leakage along the interface

Phillips Science Of Dental Materials. 11th ed.

Materials for luting


Zinc phosphate cement
Zinc polycarboxylate cement
Resin cements
Glass ionomer cements
ZOE

Zinc phosphate
Oldest - luting cements
Commercial names

Harvard cement

Introduced by PIERCE 1879.


Temporary restoration
Luting agent

Supplied as powder and liquid form.


Cements are classified according to the particle size
Type I fine grained 25 m
Type II medium particle size 40 m

Textbook of Operative Dentistry. Vimal Sikri. 1st ed. 2006

Powder
Composition Weight
(%)

Function

ZnO

90.2

Principal ingredient

MgO

8.2

To reduce temperature of Calcination process

SiO,

1.4

inactive filler

Bi203

0.1

Impart a smoothness to the freshly mixed


cement mass, in large amounts it may also
lengthen the setting Time

Misc. BaO,
Ba,S04,
CaO

0.1

Tannin fluoride may be added to provide a source of fluoride ions in some


products.

Craigs Restorative dental materials. 12th ed

Liquid
Composition

Weight (%)

H3P0,(free acid)

38.2

H3P04 (combined
with
Al and Zn)

16.2

Al

2.5

Zn

7.1

H20

36.0

Craigs Restorative dental materials. 12th ed

Manufacture of powder
Main ingredients of powder are sintered at

temperatures between 1000 C 1400 C.


Then ground to powder.
Particle sizeSmaller the particle size faster set of the

cement.

Phillips Science Of Dental Materials. 11th ed.

Setting reaction
POWDER

LIQUID

Phosphoric acid attacks


the surface of particles
and release zinc ions.

Zinc reacts with


aluminium to form zinc
alumino-phosphate gel

The set cement consist of unreacted zinc oxide particles in


amorphous matrix of zinc aluminophosphate.
Phillips Science Of Dental Materials. 11th ed.

Mixing slab
Combination of powder/ liquid is an exothermic reaction.
Cooled slab 18-20C

Powder/liquid ratio
Filling 2.5:1
Luting 1.5:1

Textbook of Operative Dentistry. Vimal Sikri. 1st ed. 2006

Care of the Liquid


Exposure of zinc phosphate cement liquid humid atmosphere

absorb water
Exposure to dry air loss of water.
addition of water more rapid reaction shorter setting time.
loss of water from the liquid lengthened setting time.
Tightly close bottle.
Polyethylene squeeze bottles.

Craigs Restorative dental materials. 11th ed

Manipulation
initially small portions of powder into the liquid,

minimal heat is liberated and dissipated.

Long, narrow-bladed stainless steel spatula

Spread the cement large area (control the


temperature of the mass and its setting time)
Craigs Restorative dental materials. 11th ed

Manipulation of zinc phosphate


Skinners Science of Dental Materials. 7th ed. 1973

Small increments at start partial neutralization


Later large increments in the middle of mixing period
Finally small increments are added.
Mixing procedure begins (slow maturation) and ends

(critical consistency) with small increments


Mixing 60-90seconds

Craigs Restorative dental materials. 11th ed

Frozen Slab Method


Glass slab cooled in a refrigerator at 6C-10C.
Amount of powder -frozen slab method is 50% to 75%

more than with the normal procedures.


Compressive and tensile strengths not significantly

different.
Incorporation of condensed moisture into the mix in the

frozen slab method counteracts the higher powder/liquid


ratio.

Craigs Restorative dental materials. 11th ed

The advantages of the frozen slab method are


Increase in working time (4 to 11 minutes) of the mix on the

slab.
Shorter setting time (20% to 40% less) of the mix after

placement into the mouth.


Cementation of bridges with multiple pins.

Craigs Restorative dental materials. 11th ed

Setting time
Manufacturing process
Higher sintering temperature - cement set slowly
Presence of water in liquid
Larger particle size less rapid reaction decreased surface

contact of powder and liquid.

Skinners Science of Dental Materials. 7th ed. 1973

Factors under the control of dentist


Lower temperature during mixing.
Rate of addition of powder in liquid.
Longer mixing time longer setting time.
More liquid in ratio to powder slower setting time.

Skinners Science of Dental Materials. 7th ed. 1973

Acidity
During the formation of zinc phosphate change in pH.
3minutes after start of mixing pH 3.5.
24- 48hours pH comes to neutrality.(6.6 6.8)
7 28day pH is 6.9
Thin mix both initial and 28days are approximately 0.5 unit

lower than thick mixes.

Craigs Restorative dental materials. 11th ed

Precautions include the use of


resinous, film forming, cavity varnishes; calcium hydroxide

and zinc oxide suspensions; ZOE or calcium hydroxide bases;


and, more recently, dentin bonding agents.

Craigs Restorative dental materials. 11th ed

Consistency

Temperature of slab - 18C

Temperature of slab 29.5C

Two mixes of cement prepared with identical P/L

Skinners Science of Dental Materials. 7th ed. 1973

Standard consistency is determined by Modified SLUMP

test. (ADA specification no 8)

Luting

Base

Retain alloy restoration

Thermal and chemical


insulation

Cement string from the


slab on spatula 2-3cm

Higher P/L

Craigs Restorative dental materials. 11th ed

Retention
No adhesion between tooth structure and zinc

phosphate cement.
Mechanical retention.
Thickness of film between inlay and tooth - thinner

Skinners Science of Dental Materials. 7th ed. 1973

Strength
Mixture of standard consistency consist of 1.4gm of powder and

0.5ml of liquid

Skinners Science of Dental Materials. 7th ed. 1973

75 % of maximal strength attained during 1hour.

Skinners Science of Dental Materials. 7th ed. 1973

Strength influenced by;


Initial P/L
Manner of mixing and handling
Compressive strength develops rapidly with luting

consistency reaching 2/3rd of final strength within 1


hour.

Craigs Restorative dental materials. 11th ed

Solubility and Disintegration


Cemented cast restoration, solubility of cement is important

consideration.
Thin line of cement is always exposed to oral fluid at margins
Cement line thicker then 50 micrometers.
ADA specification no 8
Solubility immersed in distilled water for 24hrs should not exceed

0.20%.

Skinners Science of Dental Materials. 7th ed. 1973

Solubility of Zinc phosphate cement in solution of


varying pH for 1 week.
Skinners Science of Dental Materials. 7th ed. 1973

Dimensional Stability
Cement exhibits shrinkage on hardening.
Normal dimensional change properly mixed cement is

brought into contact with water slight initial expansion,


Expansion slight shrinkage on the order of 0.04% to

0.06% in 7 days.

Craigs Restorative dental materials. 11th ed

Thermal and Electrical Conductivity


Primary uses of zinc phosphate cement insulating

base beneath metallic restorations.


Presence of moisture not have a significant effect on

the thermal conductivity of cement


But, moisture present under clinical conditions

greatly reduces the good electrical insulating.

Craigs Restorative dental materials. 11th ed

Biocompatibility
Cytotoxicity studies
Zinc phosphate cements are cytotoxic immediately after

mixing.
After complete setting - almost no cell damage is seen

Implantation studies
Rats and guinea pigs showed that subcutaneous

implanted zinc phosphate cements cause a pronounced


inflammatory reaction immediately after mixing, which
disappeared after a few weeks
Biocompatibility of Dental Materials. Gottfried Schmalz,
Dorthe Arenholt-Bindslev. 2009

Histopathological studies
When used as base is not a highly toxic material.
Some displacement of odontoblast layer, and

infiltrating inflammatory cells is countable, implying


the presence of a moderate lesion.
After 36 days - no signs of inflammation were

present

Biocompatibility of Dental Materials. Gottfried Schmalz,


Dorthe Arenholt-Bindslev. 2009

Application
Zinc phosphate cement is used most commonly
luting permanent metal restorations
base.
Other applications include cementation of

orthodontic bands

Zinc polycarboxylate
Developed - late 1960s.
Zinc polyacrylate cements (or zinc polycarboxylate)
Supplied as a powder and a liquid
The liquid is a water solution of polyacrylic acid
Mixed cement - Classified as pseudoplastic.

OBrien. Dental Material and their Selection. 3rd ed.

On the basis of their composition, polycarboxylate

cement are of three types


Type I powder contains 90% zinc oxide and 10%

magnesium oxide.
Type II 30-40% alumina replaces zinc oxide

powder
Type III polyacrylic acid is freeze dried and

incorporated in powder.
Textbook of Operative Dentistry. Vimal Sikri. 1st ed. 2006

Applications
Used for the cementation of cast alloy and porcelain
Restorations
Orthodontic bands
Cavity liners or base materials
Provisional restorative materials.

OBrien. Dental Material and their Selection. 3rd ed.

Setting reaction

Zinc polycarboxylate

Figure setting reaction


It occurs through the chelation of zinc of powder by the carboxylate group of
polyacrylic acid. Adhesion to the tooth occurs through chelation of calcium.

Skinners Science of Dental Materials. 7th ed. 1973

Manipulation
P/L
1.5:1 (Weight) Phillips
1:2 to 2:1. (Craig)

Powder & liquid dispensed just before mixing.


Mixed on non absorptive surface, such as a glass slab

Skinners Science of Dental Materials. 7th ed. 1973

Powder is rapidly incorporated into the liquid in large

quantities.
Mixing time 30-40sec.
Loss of luster and stringy consistency setting reaction

has progressed film thickness and proper wetting of


tooth cannot take place.

Skinners Science of Dental Materials. 7th ed. 1973

Typical consistency for water mix polycarboxylate and glassionomer cements. (OBrien 3rd ed)

Consistency of zinc polycarboxylate cement upon completion of 30 sec of


mixing. If the mixing time is prolonged or the mix is allowed lo remain on
the slab, the cement becomes dull in appearance and the material becomes
tacky to the touch.

Phillips Science Of Dental Materials. 11th ed.

Mechanical properties
Values
Compressive strength

55-67MPa (Phillips)

DTS

8-12 Mpa (OBrien)

Modulus of elasticity

6 Gpa (OBrien)

Solubility

0.1% to 0.6%
(OBrien)

Bond strength
Enamel

3.4 to 13 MPa,

Dentin

2.1 MPa.

Phillips Science Of Dental Materials. 11th ed.

Solubility
Low solubility in water
When exposed to organic acid pH <4.5, solubility

increases.
Reduction in P/L increases solubility and disintegration.

Phillips Science Of Dental Materials. 11th ed.

Biological property
pH of the cement liquid is approximately 1.7
Liquid is rapidly neutralized powder
pH of the mix rises rapidly as setting reaction

proceeds.
pH of polycarboxylate cement is higher than zinc

phosphate cement at various time interval.


Phillips Science Of Dental Materials. 11th ed.

Initial acidic nature of zinc polycarboxylate cements -

minimal irritation to pulp.


Because of larger size of the polyacrylic acid molecule

compared with phosphoric may limit diffusion through


the dentinal tubules
Excellent biocompatibility with the pulp is a major factor in

the popularity of this cement system.

Phillips Science Of Dental Materials. 11th ed.

Resin cement
Resin cement has become attractive as a luting agent

because of the development of direct-filling resins with


improved properties, the benefit of the acid-etch technique
Resin cements are essentially flowable composites of low

viscosity.

Phillips Science Of Dental Materials. 11th ed.

ADA specification no 27 describes 3 classes of

composite cements.
Class I Self cured materials
Class II Light cured materials
Class III Dual cured materials

Craigs Restorative dental materials. 12th ed

Chemically activated resin


Commercially available as
Two component systems
Powder- liquid
Paste-paste

Phillips Science Of Dental Materials. 11th ed.

The two components are combined by mixing on a paper

pad for 20 to 30 sec.


Removal of the excess cement is difficult if it is delayed

until the cement has polymerized


It is best to remove the excess cement immediately after

the prosthesis is seated.


This cement is suitable for all types of prostheses

Phillips Science Of Dental Materials. 11th ed.

Light curable
Single -component systems.
Available as RelyX Unicem Self-Adhesive Resin Cement. Variolink

II resin cement. Ivoclar.


Indicated
Cementation of thin ceramic prostheses
Resin-based prostheses
Direct bonding of ceramic and plastic orthodontic brackets when

the thickness of the appliance in the bonded area is less than


1.5 mm

Phillips Science Of Dental Materials. 11th ed.

Through the ceramic restoration, Exposure of light

not less than 40sec.


Excess cement removed as soon as seating is

completed.

Dual cure cements


Self cure and light cure.
Available as PANAVIA F 2.0 by Kurray America Inc.

Scotchbond Resin cement 3M Co. St. Paul, MN, USA.


Chemical activation is very slow and provides extended

working time until the cement is exposed to the curing light,


at which point the cement hardens rapidly.

Phillips Science Of Dental Materials. 11th ed.

Dual -cure cements should not be used with light

transmitting prostheses thicker than 2.5 mm; anything


thicker than 2.5 mm should be bonded with chemically
curable cement.
Removal of excess cement may proceed upon completion of

seating

Phillips Science Of Dental Materials. 11th ed.

Miscellaneous
Mineral trioxide aggregate
Biodentine
I Root BP

MINERAL TRIOXIDE AGGREGATE

MINERAL TRIOXIDE AGGREGATE


Introduced by TORABINEJAD (1993).
Commercially MTA is available (ProRoot MTA; Tulsa Dental

Products, Tulsa, OK, USA) in grey and white forms.


MTA was first described in the dental scientific literature in 1993
Approved for endodontic use by the U.S. Food and Drug

Administration in 1998.

Torabinejad M, Watson TF and Ford TRP. Sealing Ability of a Mineral Trioxide


Aggregate When Used As a Root End Filling Material. J endod 1993;19(12)
591-5.

Indications
Pulp capping with MTA on human primary (Farsi et al. 2005, Maroto
et al. 2005, 2006)

and permanent

(Farsi et al. 2006)

Other indications
Apexification
Apexogenesis
Internal and external resorption
Close iatrogenic perforations of roots (Lee et al. 1993)
Lateral or furcation involvement
Retrograde filling of root ends (Torabinejad et al. 1995)
Furcations (Pitt Ford et al. 1995).

Composition
Mineral trioxide aggregate (MTA)
Portland cement (75%)
Bismuth oxide (20%)
Gypsum (5%).
Contains trace amounts of SiO2, CaO, MgO, K2SO4 and

Na2SO4.

Roberts HS, Toth JM, Berzins DW, Charlton DG. Mineral trioxide aggregate
material use in endodontic treatment: A review of the literature. Dental
materials 24(2008) 149164.

Composition
Major content is a mixture of
Dicalcium silicate
Tricalcium silicate
Tricalcium aluminate
Gypsum
Tetracalcium aluminoferrite

On addition of water the cement hydrates to form silicate

hydrate gel - solidifies to a hard structure in less than 4 hours.


Roberts HS, Toth JM, Berzins DW, Charlton DG. Mineral trioxide aggregate
material use in endodontic treatment: A review of the literature. Dental
materials 24(2008) 149164.

Asgary S, Parirokh M, Egbbal MJ, Brink F. Chemical differences between white and
gray mineral trioxide aggregate. J Endod 2005;31:1013.

Manipulation
Torabinejad 1995;
Product high alkalinity, whose
pH is 10.2 during manipulation
12.5 after 3 hours.

MTA powder mixed with sterile water


Ratio 3:1.

Roberts HS, Toth JM, Berzins DW, Charlton DG. Mineral trioxide aggregate
material use in endodontic treatment: A review of the literature. Dental
materials 24(2008) 149164.

Mixture contact with exposure using a Dovgan carrier.


Compress the mixture against the exposure site moist

cotton pellet.
Place a moist cotton pellet temporarily placed over the MTA

left until a follow-up appointment.


Upon hydration, MTA materials form a colloidal gel that

solidifies to a hard structure in approximately 34h.

Roberts HS, Toth JM, Berzins DW, Charlton DG. Mineral trioxide aggregate
material use in endodontic treatment: A review of the literature. Dental
materials 24(2008) 149164.

The setting process is described as Hydration reaction of tricalcium silicate (3CaOSiO2) and

dicalcium silicate (2CaOSiO2), which the latter is said to be


responsible for the development of material strength.

Although weaker than other materials used for similar

purposes, MTA compressive strength has been reported to


increase in the presence of moisture for up to 21 day

Roberts HS, Toth JM, Berzins DW, Charlton DG. Mineral trioxide aggregate
material use in endodontic treatment: A review of the literature. Dental
materials 24(2008) 149164.

Studies have shown


MTA stimulates dentin bridge formation adjacent to the

dental pulp because of its property of;

sealing ability

Biocompatibility

alkalinity.

Sarkar NK, Caicedo R, Ritwik P, Moiseyeva R, and Kawashima I.


Physicochemical Basis of the Biologic Properties of Mineral Trioxide
Aggregate. J Endod 2005;31:2:97-100

A
Cut face of the mesial half of a 28
with remnants of the capping (CP)
and restorative material (white plug
in the cavity preparation and pulp
chamber). x7

B
Histological section of the specimen.
Note the cavity opening into the
pulp chamber, remnants of the
capping material (CP) and healthy
remaining pulp (PU). x18

Pulpal response to mineral trioxide aggregate (MTA) capping after 1 week


observation. Distal macrophotographic view
Nair PNR, Duncan HF, Pitt Ford TR & Luder HU. Histological, ultrastructural and
quantitative investigations on the response of healthy human pulps to experimental
capping with mineral trioxide aggregate: a randomized controlled trial. Int Endod J.
2008:41;128150.

D
The rectangular areas demarcated in (b) and (c) are magnified in
(c) and (d) respectively. Note the pulpcap interface with fibrous
encapsulation (arrowheads) and absence of pulpal inflammation.
Original magnifications: C - x90, D- x220

MTA

Results

1week

Presence of a fibrous capsule


Absence of pulpal inflammatory cells.
Signs of Necrosis and Mild hyperaemia was evident in some
of the sample
Exposed pulp tissue direct contact revealed a mild
inflammation with mixed inflammatory cell infiltrate.

1month

Some showed complete hard tissue


pulpal cells lining the hard tissue barrier were mostly
cuboidal, but also columnar cells were seen
TEM examination revealed cytoplasmic processes projecting
into the bridge
No evidence of necrosis or inflammation

3months

complete hard tissue bridge.


Some showed complete bridges were devoid of pulpal
inflammation.
one with an incomplete bridge
light microscopic evidence of tubule formation at the pulpal
aspect of the dentine bridge,that was lined by mostly
cuboidal cells.
TEM examination revealed structures reminiscent of dentinal
tubules in early stages of development containing cytoplasm
of the lining cells

Calcium hydroxide
Amorphous
Precipitations of coarse calcium granulations, constituting the so

called superficial granular zone, which is associated with the


initial synthesis and deposition of disorganised dentin matrix.

Reston EG and de Souza Costa CA. Scanning electron microscopy evaluation


of the hard tissue barrier after pulp capping with calcium hydroxide, mineral
trioxide aggregate (MTA) or ProRoot MTA. Aust Endod J 2009; 35: 7884

Mixed type
External layer is irregular and atubular, the internal layer

exhibits the typical dentinal characteristics with pre-dentin and


irregular, tortuous, randomly distributed tubules,similar to
those present in the reparativedentin

Localisation of barrier - Peripheral

Reston EG and de Souza Costa CA. Scanning electron microscopy evaluation


of the hard tissue barrier after pulp capping with calcium hydroxide, mineral
trioxide aggregate (MTA) or ProRoot MTA. Aust Endod J 2009; 35: 7884

MTA
Hard tissue barriers with predominance of dentinal tubules.
Mixed hard tissue barriers were also found.
Localisation of the barriers - occurred in the

centroperipheral area.

Reston EG and de Souza Costa CA. Scanning electron microscopy evaluation


of the hard tissue barrier after pulp capping with calcium hydroxide, mineral
trioxide aggregate (MTA) or ProRoot MTA. Aust Endod J 2009; 35: 7884

Morphology. Example of an
amorphous Ca(OH)2-induced
hard tissue barrier.

Morphology. Example of a tubular


ProRoot mineral trioxide aggregateinduced hard tissue barrier. 3000x

Reston EG and de Souza Costa CA. Scanning electron microscopy evaluation


of the hard tissue barrier after pulp capping with calcium hydroxide, mineral
trioxide aggregate (MTA) or ProRoot MTA. Aust Endod J 2009; 35: 7884

BIODENTINE

www.septodont.com

Introduced in 2005 by Prof. About, University of Marseille,

France.
Indirect pulp capping in rat molars- Prof. Michel Goldberg

(2009)
Direct pulp capping - Prof. Gilles Koubi (2011)
Endodontic application Prof. Pierre Machtou(2011)

www.septodont.com

Composition
Tricalcium silicate powder
Aqueous calcium chloride solution

Properties
It is a bioactive dentine substitute
Mechanical properties similar to the sound dentine and can

replace it both in the crown and in the root.


Contains mainly high-purity, monomer-free mineral

ingredients.

www.septodont.com

Mixing instruction
Take a capsule and gently tap it on a hard surface to loosen

the powder.
Open a capsule and place it on the stand.
Detach a single-dose container of liquid and gently tap on

the sealed cap to force all the liquid down the container.
Twist cap to open.
Squeeze out the entire contents of the single-dose container

into the capsule. Close the capsule.

Place the capsule on a mixing device, such as Technomix, Tac

400 (Lineatac), Silamat, CapMix, Rotomix, Ultramat etc., at a


speed of 4000 4200 rotations/min, and mix for 30sec.
Open the capsule and collect Biodentine material with a

suitable instrument.
Rapidly rinse and clean the instruments to remove any

residual material.
Mixing time 6min, Setting time 6min

Indications
When used in the crown:

Temporary enamel restorative material.

Permanent dentine restorative material.

Restoration of deep and/or large coronal carious lesions


(sandwich technique).

Restoration of deep cervical and/or radicular lesions.

Pulp capping.

Pulpotomy.

www.septodont.com

When used in the root:

- Repair of root perforations.


- Repair of furcation perforations.
- Repair of perforating internal resorptions.
- Repair of external resorption
- Apexification.
- Root-end filling in endodontic surgery (retrograde
filling).

I Root BP

http://www.veriodent.com

Working time of 30+ minutes, iRoot BP.


Material is available in preloaded syringes and in a moldable

putty form
Application Uses:
Pulp Capping
Apexification
Repair of Root Perforation
Repair of Root Resorption
Root End Filling

http://www.veriodent.com

Properties:
Highly Bioactive & Biocompatible
Hydrophilic
High Ph >12 / Antibacterial
Compressive Strength - 70~90 Mpa
Excellent Radiopacity

http://www.veriodent.com

Properties of dental cements


1.

Film thickness and consistency

Typically in range of 25-150m. (Phillips)


Determination of film thickness
Well mixed, non-granular

Craigs Restorative dental materials. 12th ed


Phillips Science of Dental Material. 11th ed.

Factors affecting film thickness


Particle size of powder
Concentration of powder in liquid
Viscosity of the liquid
Consistency of the cement
Amount of force during cementation
Manner in which force is applied in restoration

Craigs Restorative dental materials. 12th ed

Consistency
Heavier Consistency more, Thickness is more
Leading to less complete seating of the restoration.

Craigs Restorative dental materials. 12th ed

Craigs Restorative dental materials. 12th ed

2. Viscosity
Increase by increase in temperature and time.
Prompt cementation after completion of mixing.
Delay cause;
Increase in film thickness
Insufficient seating of restoration.

Craigs Restorative dental materials. 12th ed

3. Setting time
Determined by ANSI/ADA Specification No. 96.
A sufficient period of time after mixing
To seat and finally adapt the margins of a casting,
To seat and adjust a series of orthodontic bands, or
To properly contour a base or provisional restoration

Craigs Restorative dental materials. 12th ed

Adequate working time is expressed by proper net setting

time,
2.5 and 8 minutes at a body temperature of 37C.

60 to 90 seconds consumed by mixing the powder and

liquid.
Net setting time is the time at which cement is sufficiently

hard to resist indentation by standard indenter.

Craigs Restorative dental materials. 12th ed

4. Strength
Standard luting cement - 24-hour compressive strength of 70 MPa.

Craigs Restorative dental materials. 12th ed

5. Solubility
Water and oral fluids
Water based cements > resin/oil based

Craigs Restorative dental materials. 12th ed

Craigs Restorative dental materials. 12th ed

Bibliography
Skinners Science Of Dental Materials. 7th ed.
Craigs. Restorative Dental Material. 13th ed
Craigs. Restorative Dental Material. 12th ed
Phillips Science Of Dental Materials. 11th ed.
OBrien dental material and their selection. 3rd ed.2002
An atlas of glass ionomer cement. GJ Mount. 3rd ed. 2002.

Sturdevants art and science of dental materials. 4th ed.


Sturdevants art and science of dental materials. 5th ed.
Principles and practice of operative dentistry. Charbeneau. 2 nd

ed.1981.
Textbook of Operative Dentistry. Vimal Sikri. 1st ed. 2006
Biocompatibility of Dental Materials. Gottfried Schmalz, Dorthe

Arenholt-Bindslev. 2009

Referred articles
Journal of History of Dentistry 2005;July, 53(2):63-72.

Contemporary Permanent Luting Agents Used in Dentistry: A Literature

Review Ebru SMER1, Yaln DEER2(Int Dent Res 2011;1:26-31)

Preserving the Vital Pulp in Operative Dentistry: 3. Thickness of

Remaining cavity Dentine as a Key Mediator of Pulpal Injury and Repair


Responses. PETER E. MURRAY, PHILIP J. LUMLEY AND ANTHONY J.
SMITH. Dental Update May 2002

Torabinejad M, Watson TF and Ford TRP. Sealing Ability of a Mineral

Trioxide Aggregate When Used As a Root End Filling Material. J endod


1993;19(12) 591-5.

Mohammadi &Dummer; properties and applications of calcium

hydroxide in endodontics and dental traumatology. Int Endod


J:2011;44,697-730.

Nair PNR, Duncan HF, Pitt Ford TR & Luder HU. Histological,

ultrastructural and quantitative investigations on the response of


healthy human pulps to experimental capping with mineral trioxide
aggregate: a randomized controlled trial. Int Endod J. 2008:41;128
150.

De Bruyne MAA, De Moor RJG. The use of glass ionomer cements

in both conventional and surgical endodontics. Int Endod


J.2004;37:91-104.
AUJ Yap, SY Tham, LY Zhu, HK Lee. Short-Term Fluoride Release

from Various Aesthetic Restorative Materials. Oper Dent


2002;27:259-266
Reston EG and de Souza Costa CA. Scanning electron microscopy

evaluation of the hard tissue barrier after pulp capping with


calcium hydroxide, mineral trioxide aggregate (MTA) or ProRoot
MTA. Aust Endod J 2009; 35: 7884

Roberts HS, Toth JM, Berzins DW, Charlton DG. Mineral trioxide

aggregate material use in endodontic treatment: A review of the


literature. Dental materials 24(2008) 149164.
Sarkar NK, Caicedo R, Ritwik P, Moiseyeva R, and Kawashima I.

Physicochemical Basis of the Biologic Properties of Mineral Trioxide


Aggregate. J Endod 2005;31:2:97-100

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