CPR Part 4: Starting at MATERIALS, C&B Cements, Provisional materials, Bonding agents, Temporary restorative materials (IRM)

Starting at MATERIALS on slide 37 of Kelsey's & slide 120 of Julia's

Ideal Cement Characteristics

Crowns & Bridges

These are all Cements for ____ & ____

Temporary cements

Zinc oxide Eugenol (ZOE)

Zinc Polycarboxylate

Zinc Oxide Non-Eugenol (ZONE)

Durelon

Final Luting cements

Glass Ionomers

RMGI (peoples cement)

Bonding cements:

Light cure resin cement

Dual cure resin cement

Total etch resin cement

Self etch resin cement

Self adhesive resin cement

read what temp cements are for at the top

Temporary

These are ____ Cements that could be used to Temporarily cement a Crown or Bridge

Zinc Oxide Non-Eugenol (ZONE)

Zinc oxide Eugenol (ZOE)

Zinc Polycarboxylate

Durelon

Zinc Oxide Non-Eugenol (ZONE)

Zinc oxide Eugenol (ZOE)

Zinc Polycarboxylate

Durelon

List 4 Temporary cements that could be used to Cement a Crown/Bridge

Zinc Oxide Non-Eugenol (ZONE)

Type of temporary cement

Sets in 3 minutes and 30 seconds

Ideal for temporary cementation of crowns, bridges and all provisional needs

WE USE THIS FOR OUR TEMPS 99% OF THE TIME!!!!

Zinc Oxide Eugenol (ZOE

Type of temporary cement

Formulations with or without eugenol

Therefore CAN interfere w resin cementation

Low strength

Easy to use

Non-irritating to pulp

Eugenol= clove oil

- Can ALSO be used as a a Cavity BASE

Zinc Polycarboxylate

- (now we have better options for perm cements)

Type of temporary cement

Historically used to be a final cement, now is a temp cements

Slight bond to tooth

Non-irritating to pulp

Corrosive chemical reaction with titanium

Short working time

Viscous

Zinc Oxide Non-Eugenol (ZONE)

Ideal cement for temporary cementation of crowns, bridges and all provisional needs

WE USE THIS FOR OUR TEMPS 99% OF THE TIME!!!!

Zinc Oxide Non-Eugenol (ZONE)

OHC MOST COMMON Temporary Cement we uses for crowns, bridges, & all provisional needs

Durelon

Type of temporary cement

Used to be permanent cement

Now used as temp

Indicated if pt is going on vacation for long time

Glass Ionomers

Final Luting cement for C&B's

Acid - Base chemistry

Liquid is Polyacrylic Acid

Powder is Aluminosilicate Glass with Fluoride releasing properties

Advantages: chemical adhesion to the tooth, fluoride release, high strength, hydrophilic

Disadvantages: low pH,mildly moisture sensitive before set, low wear resistance

(bc its more soluble to water & liquid environments)

Polyacrylic Acid

Aluminosilicate Glass

For Glass Ionomers C&B cements:

Liquid is _____ _____

Powder is ____ ______ with Fluoride (releasing properties)

Resin Modified Glass Ionomer ("people's cement")

- RelyX Luting Plus

Final Luting cement for C&B's

Most commonly used/most popular cement used today!!

Acid - Base chemistry

Liquid is monomer and polyacrylic acid

Powder is the same as GI plus initiators

Advantages: very low solubility, fluoride release, high strength, thin film, easy clean-up

Disadvantages: absorbs water

(So there is a risk that a crown seated w this type of cement can pop out of the pts mouth)

Used for restorations which are not bonded in place: PFM, Gold, Zirconia (with some expectations)

(bc its a luting cement!!)

Resin Modified Glass Ionomer ("people's cement")

Most commonly used/most popular cement used today!!

Example:

RelyX Luting Plus

Used for restorations which are not bonded in place: PFM, Gold, Zirconia (with some expectations)

Resin Modified Glass Ionomer ("people's cement")

Cement used for restorations which are not bonded in place: PFM, Gold, Zirconia (with some expectations)

- bc its a luting cement!!

Resin Modified Glass Ionomer ("people's cement")

Most commonly used/most popular cement used today!!

Example:

RelyX Luting Plus

a RMGI cement= RelyX Luting Plus

- most commonly used cement

What Final Cement would you use to cement a Zirconia crown?

review top section about Bonding cements

- theyre all covered already in Part 3

Silica based restorations

Resin cements bond best to what based restorations?

which contain silica?

- Porcelain

- E.Max crowns (Lithium Disilicate)

- Feldspathic

- Zirconia (NO SILICA at all)

◦So for these 2 its great to use a completely resin cement bc you will get COMPLETE bonding btw the 2 structure !

- most cements used today are RESIN CEMENTS

Porcelain

Lithium disilicate (eMax)

◦So for these 2 its great to use a completely resin cement bc you will get COMPLETE bonding btw the 2 structure !

The most common silica based restorations are _____ and ____ ______

• This chemistry is very similar to composite restorations

Total-Etch Resin Cement

Crown & Bridge Provisional Materials

Provisional

These are Custom Crown & Bridge _____ Material Options:

Polymethyl Methacrylate (PMMA)- Jet Acrylic

PolyEthyl Methacrylate- NO HEAT- Trim and Snap

VLS- Visible Light Cured Urethane Dimethylacryate- Triad

Bis-acryl Composite Resin- Protemp Integrity

Pre-Fabricated

Custom

These are _____ Crown & Bridge Provisional Material Options

Stock Aluminum

Anatomic Metal Crown Form

Clear Celluloid

These are _____ Crown & Bridge Provisional Material Options

Polymethyl Methacrylate- Jet Acrylic

PolyEthyl Methacrylate- NO HEAT- Trim and Snap

VLS- Visible Light Cured Urethane Dimethylacryate- Triad

Bis-acryl Composite Resin- Protemp Integrity

Polymethyl Methacrylate (PMMA)- Jet Acrylic

PolyEthyl Methacrylate- NO HEAT- Trim and Snap

VLS- Visible Light Cured Urethane Dimethylacryate- Triad

Bis-acryl Composite Resin- Protemp Integrity

List 4 Materials that could be used to make a Provisional Crown & Bridge

Jet acrylic

Heat & Snap

Triad

Protemp Integrity

Custom Crown & Bridge Provisional Material Options:

Polymethyl Methacrylate-

PolyEthyl Methacrylate-

VLS- Visible Light Cured Urethane Dimethylacryate

Bis-acryl Composite Resin-

Polymethyl Methacrylate- Jet Acrylic

Custom Crown & Bridge Provisional Material Options:

Advantages- wear resistant, color stable, polishable,

esthetics, low cost

Disadvantages- HEAT (damages pulp)!!!, “Shrinks and stinks”

Polymethyl Methacrylate- Jet Acrylic

Custom Crown & Bridge Provisional Material Options:

Disadvantages- HEAT (damages pulp)!!!, “Shrinks and stinks”

PolyEthyl Methacrylate (PMMA)- NO HEAT- Trim and Snap

Custom Crown & Bridge Provisional Material Options:

Advantages- LOW heat, extended working time, low cost

Disadvantages- wear resistance, esthetics, color stability,

odor

VLS- Visible Light Cured Urethane Dimethylacryate- Triad

Custom Crown & Bridge Provisional Material Options:

Advantages- stain and wear resistant, esthetic

Disadvantages- unpleasant taste, allergies, dust from

grinding, expensive

Bis-acryl Composite Resin- Protemp Integrity

- Luxatemp

Custom Crown & Bridge Provisional Material Options:

Advantages- low curing temp, minimal shrinkage, high

tensile strength and hardness, improved margins, color

stability, less odor, high polishability

Disadvantages- Expensive

- This is the Provisional material we use at school!!

BIS-GMA/BIS ACryl (Integrity)

- more of a composite consistency

Provisional material we use at UNE

- name & brand

- review from another Q

NO

- integrity wont stick to integrity

- you will have to bond & use Flowable composite to readjust/reline a provisional

After you create the Provisional crown using BIS GMA (Integrity) and it needs a reline can you just add some more integrity to make it fit better?

- review from another Q

flowable composite

- Always use flowable composite for a reline of a Provisional made from BIS GMA!!!!!

When you use BIS GMA for a provisional & it needs a reline, you ALWAYS use _____ ____ to make any adjustments!!!

- NEVER use Integrity

- Integrity will NOT stick to integrity

- review from another Q

Bis-acryl Composite Resin- Protemp Integrity

- Luxatemp

Sandy

(when u mix them tg it will be like a sandy mix)

(sand + water= dry rough mix)

Stringy

(material sicks to the fingers or instruments & will separate into strings)

Dough-Like

(this is the stage where you adapt the material into a provisional crown)

Rubbery/Plastic

(material useless @ this stage)

Stiff/Set

Custom Crown & Bridge Provisional Material Options:

5 stages that happen while mixing Jet Acrylic (PMMA)

- Mixing/setting stages of Acrylic

- review from other Q

Stiff/Set stage of mixing Jet Acrylic

Custom Crown & Bridge Provisional Material Options:

Chemically-activated acrylic resins will reach a hard set after 6-12 minutes

- The acrylic will be hard to the touch and no longer release heat

- review from other Q

Bonding

These are the 3 ____ Agents we use at the OHC

ScotchBond Universal (we use this one in sim)

Optibond Solo Plus

Scotchbond Universal Dual Cure (use din clinic for Luxacore temp material)

- read about each in photo!!

Scotchbond Universal Dual Cure (use din clinic for Luxacore temp material)

ScotchBond Universal (we use this one in sim)

Optibond Solo Plus (composite)

Scotchbond Universal Dual Cure (Luxacore Core BLD-UP temp material)

List 3 Bonding Agents we use at the OHC

Scotch Bond Universal

Optibond Solo Plus

Scotchbond Universal Dual Cure

Bonding agent used in SIM=

Bonding agent used in Clinic for Composite Resin=

Bonding agent used for Luxacore temp material=

(Most common material for Core BLD-UP)

Scotch Bond Universal

Bonding agent used in SIM=

Optibond Solo Plus

Bonding agent used in Clinic for Composite Resin=

Scotchbond Universal Dual Cure

Bonding agent used for Luxacore temp material=

(Most common material for Core BLD-UP)

Luxacore temp provisional material

Scotchbond Universal Dual Cure (use din clinic for Luxacore temp material)

More dental materials

Microprime

Desensitizing agent containing Glutaraldehyde and HEMA

Apply Two-1 Minute coats & air dry inbetween

Indispensable prior to the luting or cementation of indirect restorations

Need to be air dried after application

UltraSeal XT Plus

Pit and fissure sealant

Flowable composite

Etch, spray/dry, bond, sealant application, LC 40 seconds

40s

How long do you light cure UltraSeal XT Plus for?

Etch

35-45% Phosphoric Acid → used to remove the smear layer

read top part

Composite

Indications

- Esthetics, polished at same appointment, repairable

Contraindications

- High caries/poor oral hygiene, heavy occlusal stress or bruxism, isolation difficult, subgingival lesions

Advantages

- Conserve tooth structure- less resistance/retention form, less complex

Disadvantages

- Polymerization shrinkage- microleakage, time consuming, more expensive than amalgam, technique sensitive, increased

coefficient of thermal expansion

Amalgam

Indications

- Posterior teeth, bruxism, heavy occlusal functioning (has greater wear resistance than composite, moderate to large class I and II restorations, class V lesions with non-esthetic concerns, can be used for cores for crowns

Contraindications

- Anterior teeth/esthetic areas, patient preference, small

restorations, use composite to conserve tooth structure

Advantages

- Ease of use, high compressive strength, excellent wear

resistance, long term clinical results, economic (cheaper), self sealing, increased working time

Disadvantages

- Poor esthetics, less conservative, corrosion

Glass ionomers

Most commonly used Fluoride releasing material

Critical pH!! 5.5

Rechargeable Fluoride releasing restorative material that is more moisture tolerant than composite resin

Rechargeable Fluoride releasing restorative material that is a Hybrid of GI's and resin composites that is usually used for root caries

(bc they release fluoride & are less sensitive to moisture than comp)

What is a Glass Ionomer?

What is a Resin Modified Glass Ionomer RMGI?

Glass Ionomers

Resin Modified Glass Ionomers

These are _____ ___

Fuji Triage (pink)

Fuji II

Fuji IX

Equia Forte

Ketac Fil

Ketac Molar

These are ____ ____ ____ ____

Fuji II LC

Photac Fil

Glass Ionomers

- Fuji II and Fuji IX showed comparable marginal adaptation. Fuji II restorations showed better results regarding anatomic form, secondary caries and marginal discoloration when compared to Fuji IX.

These are _____ ___

Fuji Triage (pink)

Fuji II

Fuji IX

Equia Forte

Ketac Fil

Resin Modified Glass Ionomers

These are ____ ____ ____ ____

Fuji II LC

Photac Fil

Fuji II GI photo

Fuji Triage (pink)

Fuji II

Fuji IX

Equia Forte

Ketac Fil

GI= No etch, bond OR light curing

Fuji II LC

RMGI= NO etch, bone, YES light cure

List 4 Glass Ionomers

List 1 RMGI's

Fuji Triage (pink)

Fuji II

Fuji IX

Equia Forte

Ketac Fil

List 4 Glass Ionomers

- Release the MOST Fluoride

- Root caries/not moisture sensitive

- NO ETCH

- NO BOND

- NO LIGHT CURE (no resin)

- NEED CAVITY/DENTIN CONDITIONER

- Cavity conditioner= 10s

- Dentin condiitoner= 20s

Fuji II LC

List 1 RMGI's

- Release the MOST Fluoride

- Root caries/not moisture sensitive

- NO ETCH

- NO BOND

- NO LIGHT CURE (no resin)

- NEED CAVITY/DENTIN CONDITIONER

- Cavity conditioner= 10s

- Dentin condiitoner= 20s

Review Open sandwich technique

Fuji IX GI photo

Ketac Fil GI photo

Fuji II LC RMGI photo

Equire Forte RMGI photo

Glass Ionomers

Fuji II

Fuji IX

Equia forte

Ketac Fil

Ketac Molar

Indications

● Closed/open sandwich technique with flowable/composite above it

● Lining class II amalgam

● Preventative restoration

● Atraumatic restorative treatment (ART)

● High caries risk

● Class III or class IV

● Cores or buildups when >1⁄2 tooth remains

● Root surface caries where ideal isolation cannot be obtained

Contraindications

● Anterior restorations (esthetics), high occlusal loading area

Advantages

● No etch/bond

● Less polymerization shrinkage stress

● Coefficient of thermal expansion similar to enamel/dentin

● Fluoride release- antimicrobial, more than RMGI fluoride

● Easy to use/manipulate

● More working time than RMGI

● Can be recharged with more fluoride

Disadvantages

● Wear resistance inferior to composites

Ex:

Fuji II

Fuji IX

Ketac Fil

Ketac Molar

Resin Modified Glass Ionomer

Fuji II LC

Photac Fil

Indications

● High caries risk

● Class III or V

● Cores or buildups when >1⁄2 tooth remains

● ART

● Sealants (erupting teeth)

Contraindicaitons

● Same as GI, NOT to be used for pulp capping

Advantages

● Can be recharged with fluoride

● No etch/bond

● Less polymerization shrinkage stress

Disadvantages

● Wear resistance inferior to composites

Ex:

Equia Forte

Fuji II LC

Photac Fil

False

- NOT safe for pulp capping

- Equia= NOT safe either

T/F: RMGI's such as Fuji II LC can be used for Direct Pulp Capping.

MTA

- Mineral Trioxide Aggregate

GOLD STANDARD material for Vital Pulp Therapy (Pulp Caps)

DIRECT PULP CAPS

MTA

Theracal (resin) or Vitrebond

- TheraCal LC is a light-cured, resin-modified calcium silicate filled liner designed for use in direct and indirect pulp capping and as a protective liner under composite, amalgam or other restorations

Direct Pulp Cap=

Indirect Pulp Cap=

-know

its a filler liner used for indirect pulp capping as a protective liner under composite, amalgam or other restorations

- direct pulp cap= MTA

What is Theracal used for?

MTA (mineral trioxide aggregate)

_____ is superior to ZOE, calcium hydroxide & formocresol – MTA is the gold standard.

Use for pulpotomies, pulp capping, liner/base

- review photo for other uses of MTA

MTA

Temporary

These are _____ restorative materials

IRM (Intermediate restorative material)

CAVIT

Fuji Triage (PINK)

Equia Forte Fil

IRM (Intermediate restorative material)

- zinc oxide eugenol (ZOE) restorative material

- Designed for intermediate restoraitons intended to remain in place for no

longer than one year

CAVIT

- A self cured temporary sealing compound for the temporary restoration of cavities

Fuji Triage (PINK)

- GI sealant that does NOT require isolation

- used as temp rest inbetween 2 endo appts!!

- NO ETCH or BONE

- NEEDS Cavity Conditioner

Equia Forte Fil

- RMGI that is very strong & also esthetic

- NO ETCH or BONE

- NEEDS Cavity Conditioner

Temporary Restorative materials:

IRM (Intermediate restorative material)

CAVIT

Fuji Triage (PINK)

Equia Forte Fil

IRM (Intermediate restorative material)

CAVIT

Fuji Triage (PINK)

Equia Forte Fil

List 4 Temporary Restorative Materials

Ex:

Temporary filling

Endo btw appts

IRM

A polymer reinforced zinc oxide eugenol (ZOE) restorative material

Designed for intermediate restoraitons intended to remain in place for no longer than one year

Comprised of powder and liquid

zinc oxide eugenol (ZOE)

- Only good for ONE year

IRM is made of _______

IRM

Benefits

● Eugenol content provides sedative line qualities on hypersensitive tooth pulp

● Good thermal insulator

Indications

● Temporary direct restorative filling material

(Lasts up to one year)

● Base material under NON-resin containing permanent restorations

(the eugenol interfered w resin bonding!!)

● Emergency placement prior to complete treatment

● Endo access openings

● Primary teeth that will soon exfoliate

Advantages

● Excellent abrasion resistance

● Good sealing properties

● Low solubility

Disadvantages

● Contains eugenol

● Contraindicated for direct pulp caps

● Contraindication as a base under resin- containing adhesives, restoratives or cements because eugenol may interfere with the hardening and/or cause softening of the polymeric (resin)

FALSE

- contains Eugeonl= therefore CANNOT be used under resin comp filings

- interferes w bonding & hardening

T/F: IRM does not contain Eugenol (sedative to the pulp) & therefore can be used under resin composite filings.

CAVIT

A self cured temporary sealing compound for the temporary restoration of cavities

CAVIT

Indications

● Cavit For occlusal temporary fillings

● Cavit W with increased bonding for the temporary filling after Endodontic treatments

● Cavit G for temporary inlays

Advantages

● Proven fillings material for temporary fillings

● Simple to apply with filling instrument

● Quick and void-free curing in a moist environment

● Slight expansion of the filling material ensures a well-sealed margin

Disadvantages

● Short term material

● Poor abrasion resistance

● High solubility

True!!!

T/F: The GI Fuji Triage (PINK) works well in a moist field & does NOT require isolation