Crown and Bridge Cements: Clinical Applications

Continuing Education

Crown and Bridge Cements:Clinical Applications

Authored by Sabiha S. Bunek, DDS, and John M. Powers, PhD

Course Number: 156

Upon successful completion of this CE activity 2 CE credit hours may be awarded

A Peer-Reviewed CE Activity by

Opinions expressed by CE authors are their own and may not reflect those of Dentistry Today. Mention of

specific product names does not infer endorsement by Dentistry Today. Information contained in CE articles and

courses is not a substitute for sound clinical judgment and accepted standards of care. Participants are urged to

contact their state dental boards for continuing education requirements.

Dentistry Today, Inc, is an ADA CERP Recognized Provider. ADA CERP isa service of the American Dental Association to assist dental professionalsin indentifying quality providers of continuing dental education. ADA CERPdoes not approve or endorse individual courses or instructors, nor does itimply acceptance of credit hours by boards of dentistry. Concerns orcomplaints about a CE provider may be directed to the provider or to ADA CERP at ada.org/goto/cerp.

Approved PACE Program ProviderFAGD/MAGD Credit Approval doesnot imply acceptance by a state orprovincial board of dentistry orAGD endorsement. June 1, 2012 toMay 31, 2015 AGD PACE approvalnumber: 309062

LEARNING OBJECTIVESAfter participating in this CE activity, the individual will learn: • Advantages, disadvantages, indications, and contraindi-cations of traditional crown and bridge and resin cements.

• Recommended uses of cements for metal, ceramic, andlaboratory composite restorations, and general guide-lines for surface treatment of silica- and zirconia-basedceramic restorations when using resin cements.

ABOUT THE AUTHORSDr. Bunek earned her DDS degree fromthe University of Michigan School ofDentistry, and maintains a privatepractice in Ann Arbor, Mich, focusing onaesthetic and comprehensive restorativedentistry. Since 2002, Dr. Bunek has

been actively involved with THE DENTAL ADVISOR as aconsultant, associate editor, and contributing author. Mostrecently, she was appointed editor-in-chief. In collaborationwith Drs. John Powers and John Farah, Dr. Bunek continuesthe tradition of research-based reporting and evaluation.She contributes monthly to main topic articles, and alsospends time developing and performing laboratory testingon dental materials. Dr. Bunek enjoys lecturing on digitaltechnologies as well as clinical procedures using the latestproducts and techniques. She can be reached [email protected].

Disclosure: Dr. Bunek is an owner of Dental Consultants, Inc(publisher of The Dental Advisor).

Dr. Powers graduated from the Universityof Michigan with a BS in chemistry in 1967and a PhD in dental materials andmechanical engineering in 1972. Hereceived an honorary PhD from theNippon Dental University in 2011. Dr.

Powers is senior editor of THE DENTAL ADVISOR andclinical professor of oral biomaterials, Department ofRestorative Den tistry and Prosthodontics, at the University ofTexas School of Dentistry at Houston. Dr. Powers hasauthored more than 1000 scientific articles, abstracts, books,and chapters. He is coauthor of the textbook, DentalMaterials−Properties and Manipulation, and co-editor ofCraig’s Restorative Dental Ma terials and Esthetic ColorTraining in Dentistry. He serves on the editorial boards ofmany dental journals. He has given numerous scientific andprofessional presentations in the United States, Mexico,South America, Europe, and Asia. He can be reached [email protected].

Disclosure: Dr. Powers is owner and senior vice presidentof Dental Consultants, Inc (publisher of The DentalAdvisor), and receives funding from 3M ESPE, PentronClinical, Kerr, Ivoclar Vivadent, Kuraray America, GCAmerica, and BISCO Dental Products.

INTRODUCTIONFor many years, dentistry has relied on metal and metal-ceramic restorations. Luting of these restorations was oftenaccomplished with traditional water-based cements such aszinc phosphate, polycarboxylate, and glass ionomer (GI)cements. Oil-based cements containing zinc oxide werealso used.1,2

With the advent of all-ceramic restorations based onfeldspathic, leucite-reinforced, and lithium disilicateceramics, bonding replaced luting. These restorationsrequired priming of both the tooth structure and the silica-based ceramic surface for successful bonding.1-3 Zirconia-based copings, frameworks, and full-contour restorationsare becoming more popular. This restorative materialrequires a different approach to cementation.3-7

This article focuses on the most commonly used traditionalcrown and bridge cements (GI and resin-modified glass ion -omer [RMGI]) for metal and metal-ceramic restorations andresin ce ments used for all-ceramic restorations. Advantages,disadvantages, indications, and contraindications of cementsare listed in Table 1.1,2 Re com mended uses of cements formetal, ceramic, and laboratory composite restorations arelisted in Table 2.1,2 General guidelines for surface treatment


1

Crown and Bridge Cements:Clinical ApplicationsEffective Date: 12/1/2012 Expiration Date: 12/1/2015

of silica- and zirconia-based restorations when using resin ce ments are listed in Table 3.1-3

CEMENT CHOICES: TRADITIONAL VERSUS RESIN-BASED CEMENTSTraditional Cements—Glass Ionomers and Resin-Modified Glass IonomersGIs were developed in the early 1970s and are still used asluting cements, primarily for the cementation of metal andmetal-ceramic restorations.1,2 The cement sets due to anacid-base reaction between glass powder (basic) and water-soluble polyacrylic acid. GIs are hydrophilic in nature andtolerate a moist environment, making them ideal in situationswhere isolation is challenging.8 The self-cured material

releases significant amounts of fluoride and is rechargeable,providing an excellent anticariogenic effect.9 This type ofcement also exhibits low film thickness, helping to ensureproper seating. A unique advantage of GI cements is theirability to bond chemically to tooth structure. Some drawbacksto GIs are low strength, short working time, long setting andmaturation time, and solubility when moisture is presentduring the initial setting period.10 They are available inpowder-liquid and encapsulated versions.

RMGIs were developed in the late 1980s in an attemptto retain the benefits of traditional GIs (adhesion andfluoride release) and to reduce some of the problems(hydration sensitivity, de layed set, and poor early strength).1,2

Major advancements in GI technology were due to the


2

Crown and Bridge Cements: Clinical Applications

Table 1. Advantages, Disadvantages, Indications, and Contraindictions of Cements

Advantages

Glass Ionomer Cement Resin-Modified Glass Ionomer Cement Aesthetic Resin Cement Adhesive Resin Cement Self-Adhesive Resin Cement

l High fluoride release, rechargeable

l Low chemical bond totooth

l Adhere in wetenvironment

l Low film thicknessl Low technique sensitivity

l Fluoride release,rechargeable

l Low-medium chemicaland micromechanicalbond to tooth

l Less technique sensitivethan resin cements

l Highest bond strengthl Minimal shade shift overtime, if light-cured

l Highly aesthetic

l No etching of toothstructure is needed

l No etch or primerl Easy to usel Low postoperative sensitivity

l Less technique sensitivity

l Easy cleanup

l Moisture-sensitive technique

l Sensitivity may occur iftooth is over-dried

l Most technique sensitivel Moisure sensitivel Highest chance of postoperative sensitivityif used with total-etch bonding

l Limited availability ofshades

l May require oxygen inhibition gel

l Can have shade shiftover time

l Not as strong as adhesive resin cements

l Sensitivity may occur iftooth is over-dried

l Time (24 hours) isrequired to develop maximumstrength

l Low strengthl Water sensitive duringsetting phase

l Metal and ceramic-metalrestorations

l High-strength ceramic(zirconia) crowns andbridges

l Laboratory compositesl Implant restorations

l All-ceramic crowns andveneers in aestheticzone

l All-ceramic crowns,onlays, inlays, bridges

l Metal or ceramic-metalcrowns/bridges

l High-strength ceramic(zirconia) crowns,bridges, inlays, onlays

l Maryland bridges (metalwings)

l Posts (cast metal,ceramic, fiber-reinforcedresin)

l All-ceramic crowns,onlays, inlays, bridges

l All-metal or ceramicmetal crowns/bridges

l High-strength ceramic(zirconia) crowns,bridges, inlays, onlays

l Posts (metal and fiber)

l Metal and ceramic-metalrestorations

l High-strength ceramic(zirconia) crownsandbridges

l Posts (metal)l Laboratory composites

l Thin all-ceramic restorations

l Posts

l Opaque all-ceramicrestorations

l All-ceramic veneers l Ceramic veneersl Crown or bridge withpoor retention

l Resin-bonded bridges

l All-ceramic restorations

Disadvantages

Indications

Contraindications

addition of resin. Modern RMGIsremain popular because theypossess slightly higher strengths,shortened set time, longer workingtime, and are less soluble in the oralenvironment than GIs.11 Comparedto GIs, these cements are moreresistant to water contaminationduring the setting reaction.12 Theyare available in powder-liquid andpaste-paste formulations.

Aesthetic Resin, Adhesive Resin,and Self-Adhesive Resin CementsDentistry is rapidly evolving from thecementation of metal and metal-ceramic restorations using traditionalce ments to the bonding of all-ceramicaesthetic restorations using resin-based adhesive ce ments. Resin ce -ments are composed of diacrylateresins and glass filler that containlight activators, chemical initiators, orboth.1,2 They form a micromechanical bond to toothstructure as well as to the restoration and are insoluble inoral fluids.1,2 Currently, resin cements can be classified into3 categories: aesthetic resins (bonding based on total-etchor self-etching adhesives), adhesive resins (bonding basedon self-etching pri mers), and self-adhesives (no separateetching or primer of teeth or restorations). There are severaldistinct types of all-ceramic restorations—silica-basedceramics (feldspathic, leucite-reinforced, and lithiumdisilicate) and high-strength ceramics based on zirconiaand alumina.

Aesthetic resin cements are tooth-colored or translucentcements based on diacrylate resin.1,2 They are often pro-vided with water-soluble try-in pastes. They have high flexuralstrength and high bond strengths to enamel and dentin.1,2

These cements typically require etching the tooth withphosphoric acid, followed by priming of the restoration andapplication of resin cement. Recent aesthetic resin cementsutilize self-etching bonding agents. Aesthetic resin ce ments

require a separate primer for bonding to ceramic, metal, andtooth substrates. Some examples are: RelyX Veneer (3MESPE), Lute-It! Esthetic Luting System (Pen tron Clinical),NX3 Nexus Third Gen eration (Kerr), and Vario link II (IvoclarVivadent).

Adhesive resin cements are based on acrylic ordiacrylate resin with in corporated adhesive monomers thatbond well to metal substrates.1,2 This class of cementsrequires the application of a self-etching primer to the toothbefore cementation. Some ex amples are: Multilink Automix(Ivo clar Vivadent), Panavia F 2.0 (Kuraray America), RelyXUltimate Adhesive Resin Cement (3M ESPE), and NX3XTR (Kerr).

Self-adhesive resin cements are the latest advancement inresin technology. These dual-cured materials contain anacidic adhesive monomer in the cement, eliminating the need for separate bonding agents or pri mers to achieve bonding totooth structure or the restoration.1,2 Self-adhesive ce ments appeal to many clinicians as they are quick, easy to use, and


3


decrease technique sensitivity. Cleanup is also easy withthese cements. The lack of a separate etching gel andbonding agent often allows for metal-based and ceramicrestorations to be bonded without the use of anesthetic. Self-adhesive resin cements are most commonly available inuniversal, translucent, and opaque shades.

One drawback of self-adhesive resin cements is lowerbond strengths when compared to other resin ce ments.3

Self-adhesive cements are not indicated in preparationswhere there is little retention; aesthetic or adhesive resincement should be used to assure an optimal bond.3

Many self-adhesive cements are now available inautomix delivery systems, but encapsulated and auto -dispensed products are still available. Some examples ofself-adhesive resin cements include RelyX Unicem 2 Auto -mix Self-Adhesive Resin Cement (3M ESPE), MaxcemElite (Kerr), PANAVIA SA CE MENT (Kuraray Amer ica), G-CEM (GC America), BisCem (BISCO Dental Pro ducts),and Speed Cem (Ivoclar Vivadent).

CEMENT SELECTION—WEIGHING THE OPTIONSNumerous factors influence the dentist’s decision regardingcement selection. Ease of use, cost, strength, solubility, andpostoperative sensitivity are just a few. To add to theconfusion, there are a large variety of cements to choosefrom. One type/category of cement is not ideal for everysituation; therefore, it is imperative to understand the

difference in the physical and mechanical properties, as wellas handling characteristics. The following recommendationsare based on the clinical experience of Dr. Bunek.

Metal or ceramic-metal res torations: GI or RMGI cementsare excellent choices, especially if the patient is a high-caries-risk patient and could benefit from fluoride release.

Metal posts: GIs are the best choice because they areself-cured.

Veneers: Total-etch, light-cured aesthetic resin cementsare the best choice. Self-adhesive resin cements can havea slight color shift over time that may affect the aestheticsof a veneer. Since veneer preparations often have littleretention form, the extra bond strength that total-etch resincements provide is important for longevity of the veneer. Inaddition, working time is not limited with light-curedaesthetic resin cements.13

Silica-based inlays and onlays (leucite-reinforced andlithium disilicate): Ad hesive resin cements are best for thiscategory, especially when retention is an issue. Silica-basedceramics require treatment with silane (Table 3). Ce mentswith higher bond strengths are required to guarantee adurable bond.

Silica-based crowns (leucite-reinforced and lithiumdisilicate): If the indirect restoration is not in the aestheticzone, adhesive resin cement is indicated. However, ifisolation is difficult and the preparation is retentive, self-adhesive resin cement is a good choice. If the indirect


4


restoration is in the aesthetic zone, the use of an aestheticresin cement is recommended.

Zirconia-based restorations: Zirco nia-based restora-tions with good retention can be cemented with traditionalcrown and bridge cements or self-adhesive resin cements.If retention is not ideal, then the zirconia-based restorationshould be primed with ceramic primer and bonded usingaesthetic or adhesive resin cement.3,7

Ceramic or fiber posts: Self-adhesive resin cements arefavored because they can be placed into the canal easily,and there is no need to worry about seating issues due tothe pooling of the bonding agent. Some self-adhesive resincements come with self-mixing tips that allow the clinicianto place cement directly into the canal.

Implant crown: For permanent ce mentation of animplant crown, RMGI is a good choice because of its lowfilm thickness and relatively easy cleanup. For temporarycementation of an implant crown, temporary cements canbe used.

SURFACE TREATMENT FOR SILICA- AND ZIRCONIA-BASED RESTORATIONSClinicians are often confused regarding the best way totreat the intaglio surface of silica- and zirconia-basedrestorations before cementation. Sur face treatments ofindirect restorations are a crucial step in adhesion as theyimprove the bond strength at the ceramic-cement interfaceby micromechanical and chemical bonding.3-5

Micromechanical interlocking is achieved by increasingthe surface area of indirect restorations. This can be done byetching with hydrofluoric (HF) acid or sandblasting.3-5 As ageneral rule, all silica-based restorations need to be etchedwith HF gel or sandblasted with alumina, regardless of theresin cement being used.3-5 If a silica-based restoration isfabricated through a laboratory, the technician will etch therestoration with HF gel, so there is no need for the clinician toetch it a second time unless the crown is exposed to salivaduring the try-in. If the silica-based restoration is fabricatedutilizing a chairside mill, the clinician or assistant needs toetch the internal surface with HF gel before cementation. Fornonetchable, zirconia-based restorations, sandblasting theintaglio surface with 50 µm alumina dramatically in creases the

bond strength.3-5

Chemical bonding is achieved through the use of silaneor ceramic primers. Silane has been used to bond HF gel-etched silica-based ceramics for many years. It is importantto note that all silica-based restorations re quire the use of asilane-coupling agent.14 Silane does not produce a stablebond for zirconia-based restorations because zirconia issilica-free. Note that silane products mixed by the dentisthave a limited shelf life. Stabilized silane primers arepremixed and have a longer shelf life.4,5

Zirconia requires specific primers to promote the chemicalbond at the nonsilica oxide-cement interface when theretention/resistance form is compromised.15 These primers (Z-Prime Plus [BISCO Dental Products]) contain an acidicmonomer and are compatible with dual-cured resin cements.15

Some ceramic primers (CLEARFIL CERAMIC PRIMER[Kuraray America]; Monobond Plus [Ivoclar Vivadent];Scotchbond Universal [3M ESPE]) will bond to both silica- andzirconia-based restorations.4,5

CLINICAL STUDIESNine hundred sixty-three zirconia-based ceramicrestorations (Lava Crowns and Bridges [3M ESPE]; 43%premolar crowns, 33% molar crowns, 18% anterior crowns,5% bridges, and 1% implants) were evaluated at 8 years.16

Most of these restorations were cemented with self-adhesive resin cement (RelyX Unicem Self-Adhesive ResinCement [3M ESPE]). Ninety-eight percent of the zirconiarestorations were rated excellent for resistance to marginaldiscoloration.

One thousand ninety-four restorations of more than6,300 restorations (ceramic inlays, onlays, bridges, PFMcrowns, posts, and CAD/CAM restorations) cemented withRelyX Unicem were available for evaluation at 8 years.17

Postoperative sensitivity was 1.1% of the seatedrestorations. The retention rate was more than 97%.

Another self-adhesive resin ce ment (PANAVIA SACEMENT, formerly CLEARFIL SA CEMENT) was evaluated in570 restorations at placement.18 There were no reports ofpostoperative sensitivity. This cement was recalled with 196lithium disilicate and zirconia restorations at one year. Theceramic restorations were primed with a ceramic primer


5


(CLEARFIL CERAMIC PRIMER). The debonding rate at oneyear was 2%. No marginal staining was observed.

SUMMARYCement selection can be confusing because factors suchas substrate, the type of restoration, and patient needsmust be considered. Some substrates require additionaltreatment before cementation. This article describes themost commonly used traditional crown and bridge cements

(GI and RMGI) used for metal and metal-ceramicrestorations, and resin ce ments used for all-ceramicrestorations. Advantages, disadvantages, in dications, andcontraindications of cements have been reviewed. Recom -mended uses of cements for metal, ceramic, and laboratorycomposite restorations have been presented. Generalguidelines for surface treatment of silica- and zirconia-based restorations when using resin ce ments have beendiscussed.


6


Clinical Tips3,4,5

Glass Ionomers and Resin-Modified Glass Ionomersl Clean tooth with pumice or glycerin-free polishing paste and isolate. l Use a polyacrylic acid dentin conditioner—it will improve the bond strength.

Aesthetic Resin Cementsl Try-in pastes can be removed with water, alcohol, or pumice without affecting bond strength of cement to veneer. l Bonding requires strict isolation to avoid contamination.l Thin the bonding agent with a stream of air to remove the solvent and to minimize pooling. Solvent left in thebonding agent can inhibit setting and affect the bond strength of the resin cement.

Adhesive Resin Cementsl Some cements require a gel barrier for complete setting. l Automixed capsules and automixed syringes save operator time. l Use light activation whenever possible—dual-cured cements typically have increased flexural strength and bondstrength when activated with a light.

Self-adhesive Resin Cementsl To minimize staining at enamel-ceramic margin, etch the enamel with phosphoric acid for 10 seconds beforecementation.

Additional Tipsl Do not over-dry tooth. Moisten surface with wet cotton pellet, if needed.l Excess cement is easiest to remove after brief exposure to a curing light, but hard to clean up if you light-cure toolong. Cure for 2 to 4 seconds, clean up the gross excess and the contacts, and then post cure the restoration.

l Never use light-cure only cements with zirconia-based restorations or highly opaque silica-based restorations. l Glutaraldehyde and HEMA-containing desensitizers (Gluma Plus [MicroPrime G]) can be used on dentin beforecementation to assist in decreasing postoperative sensitivity.

l Excess cement in interproximal areas can be difficult to clean up if the resin cement is not cleaned up before itsets. Diamond finishing strips (NTI Serrated Diamond Finishing Strips [AXIS Dental]) and CeriSaw (DenMat) canbe used to remove set excess cement from interproximal contacts. Use a dead-soft Tofflemire to wrap aroundcertain crown, inlay, and onlay preparations while cementing a restoration to keep the cement from getting into the interproximal areas.

l Dual- and self-cured adhesive resin cements are usually not compatible with sixth- and seventh-generationbonding agents, because these self-etching bonding agents contain acidic primers that interact with the self-curedchemistry of the resin cement. Follow manufacturers’ recommendations when bonding resin cements to toothstructure.

REFERENCES1. Powers JM, Wataha JC. Dental Materials: Properties

and Manipulation. 10th ed. St. Louis, MO: ElsevierMosby; 2012.

2. Sakaguchi RL, Powers JM, eds. Craig’s RestorativeDental Materials. 13th ed. St. Louis, MO: ElsevierMosby; 2012.

3. Powers JM, Farah JW, O’Keefe KL, et al. Guide to all-ceramic bonding. kuraraydental.com/guides/ -item/guide -to-allcer amic-bonding. AccessedSeptember 19, 2012.

4. Powers JM, O’Keefe KL. Guide to zirconia bondingessentials. kuraraydental.com/zirconia-bonding-guide.Accessed September 19, 2012.

5. Powers JM, Farah JW. Ceramic adhesives: ce mentingvs bonding. Inside Dentistry. 2010;6:70, 72.

6. Silva NR, Thompson VP, Valverde GB, et al.Comparative reliability analyses of zirconium oxide andlithium disilicate restorations in vitro and in vivo. J AmDent Assoc. 2011;142(suppl 2):4S-9S.

7. Stevenson W, Kolb B, Powers JM, et al. Resincements 101. The Dental Advisor Translating theScience, No. 8, January 2010. dentaladvisor.com/publications/translating-the-science/index.shtml.Accessed Sept 24, 2012.

8. Mount GJ. Buonocore Memorial Lecture: Glass-ionomer cements: past, present and future. Oper Dent.1994;19:82-90.

9. Forsten L. Fluoride release and uptake by glass-ionomers and related materials and its clinical effect.Biomaterials. 1998;19:503-508.

10. Davidson CL, Mjör IA. Ad vances in Glass-Ionomer Ce ments. Chicago, IL: Quin tes sence Publishing; 1999.

11. Knobloch LA, Kerby RE, McMillen K, et al. Solubility andsorption of resin-based luting cements. Oper Dent.2000;25:434-440.

12. Wilson AD. Resin-modified glass-ionomer cements. IntJ Prosthodont. 1990;3:425-429.

13. Breeding LC, Dixon DL, Caughman WF. The curingpotential of light-activated composite resin lutingagents. J Prosthet Dent. 1991;65:512-518.

14. Blatz MB, Sadan A, Kern M. Resin-ceramic bonding: areview of the literature. J Prosthet Dent. 2003;89:268-274.

15. Chen L, Suh BI, Brown D, et al. Bonding of primedzirconia ceramics: evidence of chemical bonding andimproved bond strengths. Am J Dent. 2012; 25:103-108.

16. Bunek SS, ed. 3M ESPE RelyX Unicem Self-Adhes iveResin Cement–8-year clinical performance. DentAdvis. 2012; 29(2): 9. dentaladvisor.com/clinical-evaluations/evaluations/3m-espe-relyx-unicem-self-adhesive-resin-cement-8-year.shtml. Accessed Sept 24, 2012.

17. Farah JW, Powers JM, eds. 3M ESPE Lava Crowns andBridges–8-year clinical performance. Dent Advis.2011;28(9):14. dentaladvisor.com/clinical-evaluations/evaluations/3m-espe-lava-crowns-and-bridges-8-yr.shtml. Accessed September 24, 2012.

18. Farah JW, Powers JM, eds. Clearfil SA Cement andClearfil Ceramic Primer–1-year clinical performance.Dent Advis. 2010;27(10): 12-13. dentaladvisor. com/ -clinical-evaluations/evaluations/clearfil-sa-cement-and-clearfil-ceramic-primer-1-yr.shtml. AccessedSeptember 24, 2012.


7


POST EXAMINATION INFORMATION

To receive continuing education credit for participation inthis educational activity you must complete the programpost examination and receive a score of 70% or better.

Traditional Completion Option:You may fax or mail your answers with payment to DentistryToday (see Traditional Completion Information on followingpage). All information requested must be provided in orderto process the program for credit. Be sure to complete your“Payment,” “Personal Certification Information,” “Answers,”and “Evaluation” forms. Your exam will be graded within 72hours of receipt. Upon successful completion of the post-exam (70% or higher), a letter of completion will be mailedto the address provided.

Online Completion Option:Use this page to review the questions and mark youranswers. Return to dentalcetoday.com and sign in. If youhave not previously purchased the program, select it fromthe “Online Courses” listing and complete the onlinepurchase process. Once purchased the program will beadded to your User History page where a Take Exam linkwill be provided directly across from the program title.Select the Take Exam link, complete all the programquestions and Submit your answers. An immediate gradereport will be provided. Upon receiving a passing grade,complete the online evaluation form. Upon submitting the form, your Letter Of Completion will be providedimmediately for printing.

General Program Information:Online users may log in to dentalcetoday.com any time inthe future to access previously purchased programs andview or print letters of completion and results.

POST EXAMINATION QUESTIONS

1. Which one of the following cements requires aseparate primer for a zirconia-based restoration withless than adequate retention?

a. Self-adhesive resin cement.

b. Aesthetic resin cement.

c. Glass ionomer (GI) cement.

d. Resin-modified glass ionomer (RMGI) cement.

2. Which one of the following cements would beexpected to provide the highest fluoride release andfluoride rechargeability?



c. GI cement.

d. RMGI cement.

3. Which one of the following substrates requireschemical pretreatment with silane coupling agent?

a. Lithium disilicate ceramic.

b. Alumina ceramic.

c. Zirconia ceramic.

d. Metal alloy.

4. Which one of the following pretreatments would bethe best choice for a zirconia-based ceramicrestoration?

a. Etching with hydrofluoric (HF) acid gel.

b. Silane.

c. Ceramic primer with acidic adhesive monomer.

d. Etching with phosphoric acid.

5. Which one of the following cements requires the useof separate self-etch or total-etch bonding agent forbonding to enamel and dentin?



c. Temporary resin cement.

d. RMGI cement.

6. Which one of the following cements is recommendedfor cementation of aesthetic fiber posts?



c. GI cement.

d. RMGI cement.

7. Which one of the following cements is recommendedfor permanent cementation of an implant-supportedcrown?



c. GI cement.

d. RMGI cement.


8


8. Which one of the following substrates does notrequire pretreatment with silane?

a. Lithium disilicate ceramic.

b. Leucite-reinforced ceramic.

c. Zirconia ceramic.

d. Feldspathic porcelain.

9. Which of the following is the best micromechanicalpretreatment for the intaglio surface of a zirconia-based restoration?

a. Etching with HF acid gel.

b. Sandblasting with 50 µm alumina.

c. Etching with phosphoric acid.

d. Silane.

10. Which one of the following cements would beexpected to provide the highest flexural strength?



c. GI cement.

d. RMGI cement.

11. Use of a polyacrylic acid dentin conditioner withGI cement will:

a. Increase the flexural strength of the cement.

b. Reduce the early solubility of the cement.

c. Increase the fluoride release of the cement.

d. Improve the bond strength of the cement.

12. Which one of the following cements might require a gel barrier to minimize the air-inhibited layer andensure adequate polymerization?

a. Adhesive resin cement.


c. GI cement.

d. RMGI cement.

13. Dual- and self-cured resin cements are usually notcompatible with which one of the following types ofbonding agents due to the high acidity of thebonding agent?

a. Seventh-generation bonding agents.

b. Etch-and-rinse bonding agents.

c. Fourth-generation bonding agents.

d. Fifth-generation bonding agents.

14. Which one of the following types of restorationsshould probably not be bonded with light-cured onlyresin cement?

a. Lithium disilicate ceramic veneer.

b. Leucite-reinforced ceramic anterior veneer.

c. Feldspathic porcelain anterior veneer.

d. High-strength zirconia-based restoration.

15. The use of phosphoric acid etching with self-adhesive resin cement might be recommended to:

a. Improve the bond strength of the cement to dentin.

b. Reduce postoperative sensitivity.

c. Increase the benefit of fluoride release of the cement.

d. Minimize staining at enamel-restoration margin.

16. Try-in pastes should be removed from toothstructure before bonding with aesthetic resin cement by:

a. Rinsing with phosphoric acid.

b. Microetching with aluminum oxide powder.

c. Rinsing with water or alcohol.

d. Using medium-grit prophy paste.


9


PROGRAM COMPLETION INFORMATION

If you wish to purchase and complete this activitytraditionally (mail or fax) rather than online, you mustprovide the information requested below. Please be sure toselect your answers carefully and complete the evaluationinformation. To receive credit you must answer at least 12 ofthe 16 questions correctly.

Complete online at: dentalcetoday.com

TRADITIONAL COMPLETION INFORMATION:Mail or fax this completed form with payment to:

Dentistry TodayDepartment of Continuing Education100 Passaic AvenueFairfield, NJ 07004

Fax: 973-882-3622

PAYMENT & CREDIT INFORMATION:

Examination Fee: $40.00 Credit Hours: 2.0

Note: There is a $10 surcharge to process a check drawn on any bank other than a US bank. Should you have additionalquestions, please contact us at (973) 882-4700.

� I have enclosed a check or money order.

� I am using a credit card.

My Credit Card information is provided below.

� American Express � Visa � MC � Discover

Please provide the following (please print clearly):

Exact Name on Credit Card

Credit Card # Expiration Date

Signature

PROGRAM EVAUATION FORMPlease complete the following activity evaluation questions.

Rating Scale: Excellent = 5 and Poor = 0

Course objectives were achieved.

Content was useful and benefited your clinical practice.

Review questions were clear and relevant to the editorial.

Illustrations and photographs were clear and relevant.

Written presentation was informative and concise.

How much time did you spend reading the activity and completing the test?

What aspect of this course was most helpful and why?

What topics interest you for future Dentistry Today CE courses?



ANSWER FORM: COURSE #: 156Please check the correct box for each question below.

1. � a � b � c � d 9. � a � b � c � d

2. � a � b � c � d 10. � a � b � c � d

3. � a � b � c � d 11. � a � b � c � d

4. � a � b � c � d 12. � a � b � c � d

5. � a � b � c � d 13. � a � b � c � d

6. � a � b � c � d 14. � a � b � c � d

7. � a � b � c � d 15. � a � b � c � d

8. � a � b � c � d 16. � a � b � c � d

PERSONAL CERTIFICATION INFORMATION:

Last Name (PLEASE PRINT CLEARLY OR TYPE)

First Name

Profession / Credentials License Number

Street Address

Suite or Apartment Number

City State Zip Code

Daytime Telephone Number With Area Code

Fax Number With Area Code

E-mail Address

/

Dentistry Today, Inc, is an ADA CERP RecognizedProvider. ADA CERP is a service of the AmericanDental Association to assist dental professionals inindentifying quality providers of continuing dentaleducation. ADA CERP does not approve or endorseindividual courses or instructors, nor does it implyacceptance of credit hours by boards of dentistry.Concerns or complaints about a CE provider may bedirected to the provider or to ADA CERP atada.org/goto/cerp.

Approved PACE Program ProviderFAGD/MAGD Credit Approval doesnot imply acceptance by a state orprovincial board of dentistry or AGDendorsement. June 1, 2012 to May 31, 2015 AGD PACE approvalnumber: 309062

10

Documents

Crown and Bridge Cements: Clinical Applications