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Anterior cementation technique guide

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Page 1: Anterior cementation technique guide
Page 2: Anterior cementation technique guide

Advanced Cementation Update

Webinar

Advanced Cementation Update

Webinar

Page 3: Anterior cementation technique guide

WebinarOctober 14th

WebinarOctober 14th

John Nosti, DMDJohn Nosti, DMDwww.clinicalmastery.com

The Why, Where, & When of bite relationships

The Why, Where, & When of bite relationships

Page 5: Anterior cementation technique guide

CementationCementationAdhesion

“total-etch”, resin cementSemi-adhesion

Self-etching resin cementNon-adhesion

Glass Ionomer, resinionomer, zinc phosphate, polycarboxylate

Adhesion“total-etch”, resin cement

Semi-adhesionSelf-etching resin cement

Non-adhesionGlass Ionomer,

resinionomer, zinc phosphate, polycarboxylate

Page 6: Anterior cementation technique guide

Cement Requirements

Cement RequirementsLack of post-operative sensitivity

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

Easy placement and clean-upEsthetics compatible with the restorative material

Minimal film thicknessRadiopaque (posterior)

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

Easy placement and clean-upEsthetics compatible with the restorative material

Minimal film thicknessRadiopaque (posterior)

Page 7: Anterior cementation technique guide

Powder liquid ceramic or

Pressed ceramic restorations

Powder liquid ceramic or

Pressed ceramic restorations

“Total-etch”with

Resin Cement

“Total-etch”with

Resin Cement

Page 8: Anterior cementation technique guide

“Tack & Wave”

Cementation

“Tack & Wave”

CementationVeneers and anterior crownsVeneers and anterior crowns

Page 9: Anterior cementation technique guide

Emprethin evaluationEmprethin evaluation

Page 10: Anterior cementation technique guide

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

Page 11: Anterior cementation technique guide

OptraGate (Ivoclar)OptraGate (Ivoclar)

Page 12: Anterior cementation technique guide
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Hydrogen Peroxide in Ultradent SyringeHydrogen Peroxide in Ultradent Syringe

Page 14: Anterior cementation technique guide

Metal strip removes any interproximal Luxatemp and

freshens the enamel

Metal strip removes any interproximal Luxatemp and

freshens the enamel

Page 15: Anterior cementation technique guide

Try in independently

DRY

Try in independently

DRY

Page 16: Anterior cementation technique guide

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

Page 17: Anterior cementation technique guide

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

Check complete seatingProximal contacts

Check complete seatingProximal contacts

Page 18: Anterior cementation technique guide

Dry Erase Marker Dry Erase Marker

Mesial SurfaceMesial Surface

Page 19: Anterior cementation technique guide
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Distal

Surface

Distal

Surface

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Variolink Veneer(Ivoclar/Vivadent)

Variolink Veneer(Ivoclar/Vivadent)

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

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

Page 24: Anterior cementation technique guide
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00 +2+2

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

Page 30: Anterior cementation technique guide

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

Page 31: Anterior cementation technique guide

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

Page 32: Anterior cementation technique guide

Load restoration with resin cementLoad restoration with resin cement

Page 33: Anterior cementation technique guide

Vivapad (Ivoclar)Vivapad (Ivoclar)

Page 34: Anterior cementation technique guide

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

Page 35: Anterior cementation technique guide

Apply Systemp desensitizer for 15 secondsApply Systemp desensitizer for 15 seconds

Page 36: Anterior cementation technique guide

Effect of Remoistening

Water-blotted dry 22.8

Water- wet 19.2

Gluma Desensitizer 22.3

HurriSeal 20.1

Vivadent Desensitizer 25.8

MicroPrime 20.1

Aqua-Prep 18.1

Product Dentinal Bond

Water vs. Desensitizer/Rewetting

Agent

Page 37: Anterior cementation technique guide

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

Page 38: Anterior cementation technique guide

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

Page 39: Anterior cementation technique guide
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Adec Warm Air Tooth DryerAdec Warm Air Tooth Dryer

Page 41: Anterior cementation technique guide

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

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

Page 42: Anterior cementation technique guide

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

2.0 mm light guide (Ivoclar)

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

2.0 mm light guide (Ivoclar)

Page 43: Anterior cementation technique guide

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

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

Page 44: Anterior cementation technique guide

General GuidelinesGeneral

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

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

Page 45: Anterior cementation technique guide

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

Page 46: Anterior cementation technique guide

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

Page 47: Anterior cementation technique guide

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

Page 48: Anterior cementation technique guide

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

Page 49: Anterior cementation technique guide

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

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

Page 50: Anterior cementation technique guide

Curing LightsCuring Lights

PhotoinitiatorsCamphoroquinone- 470-490 nm

PhenylDipropandione- 430 nm

PhotoinitiatorsCamphoroquinone- 470-490 nm

PhenylDipropandione- 430 nm

Page 51: Anterior cementation technique guide

0

10

20

30

40

300 350 400 450 500 600

CQ

CQ 488 nm PDP 430 nm

Wavelength (nm)

Page 52: Anterior cementation technique guide

OptiLux 501(Demetron)OptiLux 501(Demetron)

Emits light with wavelength 390-510 nm

Page 53: Anterior cementation technique guide

0

10

20

30

40

300 350 400 450 500 600

CQ

CQ 488 nm PDP 430 nm

Wavelength (nm)

Page 54: Anterior cementation technique guide

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

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

-No bulb degradation

-Portable

-Wavelength output 450-500 nm

-No bulb degradation

-Portable

-Wavelength output 450-500 nm

Page 55: Anterior cementation technique guide

0

10

20

30

40

300 350 400 450 500 600

CQ

CQ 468 nm PDP 430 nm

Wavelength (nm)

Page 56: Anterior cementation technique guide

BluePhase G2(Ivoclar)

BluePhase G2(Ivoclar)

Emits light with wavelength 390-510 nm

Page 57: Anterior cementation technique guide

Fusionwww.dentlight.com

Page 58: Anterior cementation technique guide

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

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

Page 59: Anterior cementation technique guide

Run Serrated Saw through contactsRun Serrated Saw through contacts

Page 60: Anterior cementation technique guide

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

Page 61: Anterior cementation technique guide

Epitex Strips (GC)Epitex Strips (GC)

Page 62: Anterior cementation technique guide

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

Page 63: Anterior cementation technique guide

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

Page 64: Anterior cementation technique guide
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OptraFine Porcelain polishing system (Ivoclar)OptraFine Porcelain polishing system (Ivoclar)

Page 66: Anterior cementation technique guide

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

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Solid Model ContactsSolid Model Contacts

Page 72: Anterior cementation technique guide

Adhesion to the restoration

Adhesion to the restoration

Ceramist etches in labClinician cleans internal

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

resin to internal of restoration

Ceramist etches in labClinician cleans internal

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

resin to internal of restoration

Page 73: Anterior cementation technique guide

Adhesion to the restoration

Adhesion to the restoration

Ceramist etches in labClinician cleans internal

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

resin to internal of restoration

Ceramist etches in labClinician cleans internal

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

resin to internal of restoration

Page 74: Anterior cementation technique guide
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Blot Dry dentinBlot Dry dentin

Page 78: Anterior cementation technique guide

Apply primerApply primer

Page 79: Anterior cementation technique guide

Air dry primerAir dry primer

Page 80: Anterior cementation technique guide

Light polymerize for 10 secondsLight polymerize for 10 seconds

Page 81: Anterior cementation technique guide

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

Page 82: Anterior cementation technique guide
Page 83: Anterior cementation technique guide

Hold passively for 3 minutesHold passively for 3 minutes

Page 84: Anterior cementation technique guide

Remove excess with scaler or explorer

Remove excess with scaler or explorer

Page 85: Anterior cementation technique guide

Floss through contactsFloss through contacts

Page 86: Anterior cementation technique guide

Cover margins with oxygen-inhibiting medium

Cover margins with oxygen-inhibiting medium

Page 87: Anterior cementation technique guide

Light polymerize for at least 60 seconds

Light polymerize for at least 60 seconds

Page 88: Anterior cementation technique guide

Use scaler and/or #12 Bard Parker

Use scaler and/or #12 Bard Parker

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Core-reinforced RestorationsZirconiaAluminaMetal

Lithium disilicate (e.Max)

Core-reinforced RestorationsZirconiaAluminaMetal

Lithium disilicate (e.Max)

Page 93: Anterior cementation technique guide

Pressed Ceramic/Powder-liquid ceramics

Pressed Ceramic/Powder-liquid ceramics

“Total-etch” resin

cements

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

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

Conventional cements No etch Adhesive cements

High technique sensitivityHigh technique sensitivity

Page 94: Anterior cementation technique guide

e.Max PressedLithium disilicate pressed

Page 95: Anterior cementation technique guide

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

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

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

cements)

Conventional cements(Zinc phosphate, polycarboxylate,

Glass ionomer)

Page 96: Anterior cementation technique guide

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

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

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

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

No etch adhesive cements

Page 97: Anterior cementation technique guide

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

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

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

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

Page 98: Anterior cementation technique guide

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

Embrace

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

G-Cem (GC)BisCem (Bisco)

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

G-Cem (GC)BisCem (Bisco)

Page 99: Anterior cementation technique guide

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

EmbraceBisCem (Bisco)

Page 100: Anterior cementation technique guide

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

Embrace

Bond strengths (Reality)

Dentin EnamelMaxCem 3.8 8.8

Unicem 7.7 16.6

BisCem 9.0 15.0

“Total-etch” 30.3 25.4 Relyx

Page 101: Anterior cementation technique guide

Advantages of “Single Component self-adhesive” cements

Advantages of “Single Component self-adhesive” cements

Good physical properties Some adhesive properties

Very, very easy to use

Page 102: Anterior cementation technique guide

Disadvantages of “Single Component self-adhesive” cements

Disadvantages of “Single Component self-adhesive” cements

Mediocre bonds to dentin and enamel

Questionable long term enamel bonds

Questionable bonds to restorative substrate

Page 103: Anterior cementation technique guide

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

Panavia FL2.0(Kuraray)

Bistite II DC(J. Morita)

Multilink Automix(Ivoclar)

Page 104: Anterior cementation technique guide

Advantages of Assisted “Self-adhesive” cements

Advantages of Assisted “Self-adhesive” cements

Good physical properties Good adhesive properties

Easier to use than “Total-etch” cements

Page 105: Anterior cementation technique guide

Assisted “Self adhesive” cementsAssisted “Self adhesive” cements

Embrace

Bond strengths (Reality)

Dentin EnamelPanavia F 2.0 7.6 11.5

Bistite II 14.7 12.7

Multilink 15.1 16.4

“Total-etch” 30.3 25.4 Relyx

Page 106: Anterior cementation technique guide

Involves an adhesive stepBonds not as strong as

“Total-etch”

Disadvantages of Assisted “Self-adhesive” cements

Disadvantages of Assisted “Self-adhesive” cements

Page 107: Anterior cementation technique guide

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

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

Decreased bond strengths to dentin

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

Multilink 21.2 16.4

BisCem 15.0 13.8

Enamel Bonds

Page 108: Anterior cementation technique guide

When do I use what?

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

“Total etch”Core-supported Ceramic

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

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

Non-core supported ceramic:“Total etch”

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

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

Page 109: Anterior cementation technique guide

Hornbrook 2009 Updates –

Full Day Events

Hornbrook 2009 Updates –

Full Day Events

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

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