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Advanced Cementation Update
       Webinar
Clinical Mastery
    (www.clinicalmastery.com)
Over-the-shoulder Prepless veneer
 courses
Full mouth rehabilitation courses
Hands-on Occlusion Courses
Webinars
          Phoenix, Arizona
Webinar
   October 14th
The Why, Where, & When
  of bite relationships


     John Nosti, DMD
   www.clinicalmastery.com
david@hornbrook.com
Cementation
Adhesion
 “total-etch”, resin cement
Semi-adhesion
 Self-etching resin cement
Non-adhesion
 Glass Ionomer, resinionomer, zinc
  phosphate, polycarboxylate
Cement Requirements
Lack of post-operative sensitivity
Strong bond and good seal
  -to the tooth and to the restorative material
Easy placement and clean-up
Esthetics compatible with the restorative
 material
Minimal film thickness
Radiopaque (posterior)
“Total-etch”
           with
  Resin Cement
  Powder liquid ceramic
             or
Pressed ceramic restorations
“Tack &
   Wave”
Cementation
Veneers and anterior crowns
Emprethin evaluation
Be Careful!!!
0.2 mm glass is fragile!
OptraGate   (Ivoclar)
Hydrogen Peroxide in Ultradent Syringe
Metal strip removes any interproximal
 Luxatemp and freshens the enamel
Try in independently
        DRY
Occlude Spray Powder
(Pascal)
Try-in collectively DRY!

   Check complete seating
   Proximal contacts
Mesial Surface




Dry Erase Marker
Distal
Surface
Variolink Veneer
    (Ivoclar/Vivadent)


    Value based
    0
    +1, +2, +3
    -1, -2, -3
    Microfill
0   +2
Clean and acidify with 35% Phosphoric acid
Silane Coupling Agent (Relyx Ceramic primer) placed for 1 minute
Place bonding agent (All Bond 3) inside dry restoration
Load restoration with resin cement
Vivapad (Ivoclar)
Etch with 35% phosphoric acid for 15 seconds per tooth
Apply Systemp desensitizer for 15 seconds
Effect of Remoistening

Water vs. Desensitizer/Rewetting
Product
             Agent                 Dentinal Bond

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
suction” away excess; do not desiccate
Apply 2 coats of All Bond 3 A & B Primer mix
Adec Warm Air Tooth Dryer
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)
H old light guide 1 inch from restorations
and light cure 3-5 seconds on facial and lingual
General Guidelines

   +2: 5 seconds
   0: 3 seconds
   -3: 5 seconds +
“ Pick" away excess using Bard Parker or scaler
Floss through contacts using a Brasseler Serrated Saw
Floss through contacts using waxed dental floss
Place DeOx (Ultradent) on all margins
Light polymerize for at least 60 seconds
 per tooth from both buccal and lingual
Curing Lights
Photoinitiators
 Camphoroquinone- 470-490 nm
 PhenylDipropandione- 430 nm
PDP 430 nm         CQ 488 nm

40

30

20

10

 0                                          CQ
     300    350   400   450     500   600
                              Wavelength (nm)
OptiLux 501
  (Demetron)




Emits light with wavelength
        390-510 nm
PDP 430 nm         CQ 488 nm

40

30

20

10

 0                                          CQ
     300    350   400   450     500   600
                              Wavelength (nm)
LED Light
 i.e.. Freelight (3M), LEDemetron
(Kerr),,BluPhase (Ivoclar), DEMI (Kerr)…


       -No bulb degradation
                -Portable
-Wavelength output 450-500 nm
PDP 430 nm         CQ 468 nm

40

30

20

10

 0                                          CQ
     300    350   400   450     500   600
                              Wavelength (nm)
Emits light with wavelength
        390-510 nm



 BluePhase G2
   (Ivoclar)
Fusion
www.dentlight.com
Remove excess resin cement with Scaler,
   #12 & #15 Bard-parker Blades
Run Serrated Saw through contacts
1954N Strip (3M)
Epitex Strips (GC)
15 micron finishing diamond (Brasseler))
15 micron football-shaped diamond on lingual
OptraFine Porcelain polishing system (Ivoclar)
DiaShine ( V & H )
Solid Model Contacts
Adhesion to the
   restoration
Ceramist etches in lab
Clinician cleans internal surfaces
 with phosphoric acid
Rinse and dry thoroughly
Apply Silane coupling agent
Apply dual-cure adhesive resin to
 internal of restoration
Adhesion to the
   restoration
Ceramist etches in lab
Clinician cleans internal surfaces
 with phosphoric acid
Rinse and dry thoroughly
Apply Silane coupling agent
Apply dual-cure adhesive resin to
 internal of restoration
Blot Dry dentin
Apply primer
Air dry primer
ight polymerize for 10 seconds
Posterior
RelyX ARC (3M)
Hold passively for 3 minutes
Remove excess with
 scaler or explorer
Floss through contacts
Cover margins with
oxygen-inhibiting medium
Light polymerize for
 at least 60 seconds
Use scaler and/or
#12 Bard Parker
re-reinforced Restorations
       Zirconia
       Alumina
        Metal
Lithium disilicate (e.Max)
Pressed Ceramic/      “Core” reinforced ceramic
Powder-liquid ceramics( Metal, zirconium, lithium disilicate, alumina oxide)


                  High technique sensitivity



         “Total-                   Conventional cements
       etch” resin              No etch Adhesive cements
        cements
e.Max Pressed
 Lithium disilicate pressed
“Core” reinforced ceramic
   ( Metal, zirconium, lithium disilicate, alumina oxide )




   Conventional cements
Zinc phosphate, polycarboxylate,
        Glass ionomer)
                        No etch Adhesive cements
                 (Resin-ionomers, self-adhesive resin cemen
“Core” reinforced ceramic
 etal, zirconium, lithium disilicate, alumina oxi
            No etch adhesive cements



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


                 Self-adhesive resin cements
         (Unicem, MaxCem, Multilink Automix, Panavia F
“ Self-adhesive”           resin cements
 (the benefits of resin without the technique sensitivity)




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

          Assisted Self-adhesive resin cemen
                   (Multilink Automix, Panavia FL)
ingle Component Self-adhesive “ cemen

       Unicem (3M)
       MaxCem Elite (Kerr)
      Embrace



       Embrace Wetbond ( Pulpdent)
       G-Cem (GC)
       BisCem (Bisco)
ingle Component Self-adhesive “ cemen


         BisCem
      Embrace
                    (Bisco)
ingle Component Self-adhesive “ cemen
                 Bond strengths (Reality)

                    Dentin                  Enamel
       Embrace
  MaxCem                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” cement

  Good physical properties
  Some adhesive properties
    Very, very easy to use
Disadvantages of
Single Component self-adhesive” cement

    Mediocre bonds to dentin and
               enamel
   Questionable long term enamel
                bonds
       Questionable bonds to
        restorative substrate
ssisted “Self-etch” resin cement

       Panavia FL2.0
            (Kuraray)
        Bistite II DC
           (J. Morita)
     Multilink Automix
             ( Ivoclar)
Advantages of
    Assisted “Self-adhesive” cements

       Good physical properties
       Good adhesive properties
 Easier to use than “Total-etch” cement
Assisted “Self adhesive” cements
                Bond strengths (Reality)

                   Dentin                  Enamel
      Embrace
Panavia 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
Disadvantages of
Assisted “Self-adhesive” cements

 Involves an adhesive step
 Bonds not as strong as
     “Total-etch”
Can we “etch “with phosphoric
 acid with self-etch cements?
Enamel Bonds Total-etch             Self-etch
 Panavia F 2.0      18.3                   11.8
 Unicem             16.6                    8.5
 Multilink          21.2                   16.4
  BisCem            15.0                   13.8
      Decreased bond strengths to dentin
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
Hornbrook 2009 Updates –
           Full Day Events
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!
         November 6th – Albuquerque, NM
         November 13th – Boston, MA at Tufts University

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Anterior cementation technique guide