Dental Cements: Liners , Bases, and Temporary Restoration Materials

1. Dental Cements:Liners, Bases, and Temporary Restoration Materials DHYG 113 Restorative Dentistry I

2. Objectives • Describe the purpose and use of: • Calcium hydroxide • Zinc phosphate • Glass ionomer • ZOE • Temporary cement • Recall approximate setting times for each • Demonstrate proper mixing techniques (lab activity)

3. Terminology • Base • Liner • Luting agent • Obtundant • Exothermic • Dental cement • Pulp protection • Cavity sealer • Dentin bonding agent • Varnish

4. Use of Dental Cements • Luting agent = cement • Pulp protection = liner or base • Temporary restoration • Caries control • Cavity sealer = varnish • Dentin bonding agent

5. Chemistry of Dental Cements • Dental cements are typically a powder/liquid system • The liquid is an acid • The powder is a base • Powder must be insoluble in oral fluids but reactive with acid

6. Composition of powder • Two materials used to make powders for dental cements: • Zinc oxide • Powdered glass

7. Zinc oxide • The only insoluble, nontoxic, reactive oxide or hydroxide to react w/an acid • Common additives are aluminum oxide and magnesium oxide • Has some antibacterial effects • Reactivity is controlled by manufacturing process

8. Powdered Glass • The chemical form- silicon oxide - is very un-reactive • When oxides of sodium, calcium and potassium are added in sufficient quantities, the glass will react with strong acid. • Made of small translucent glass particles • Contains fluoride to reduce melting temp, improve flow of molten glass, and gives cement ability to release fluoride. • Reactivity is determined by composition of glass.

9. Dental cement liquids • Composition or strength of acid determines reactivity of the cement liquid. • Composition is controlled by the manufacturer • Liquids used in dental cements include: • Eugenol • Phosphoric acid • Polyacrylic acid

10. Eugenol • Organic liquid- weak acid • Major component of oil of cloves • Derived from phenol • Antibacterial • Obtundant -- reduces irritation to pulp • Inhibits free radical polymerization • Inhibits setting of composite restorative materials • Ethoxybenzoic acid (organic liquid) added to formulate cements.

11. Phosphoric acid • Used as 2/3 acid and 1/3 water • Very acidic and irritating to tissue • Amount of water present affects reactivity of liquid by affecting ionization. • Different levels of humidity affect it

12. Polyacrylic acid • Aqueous solutions 30-50% polyacrylic acid by weight • Very viscous liquid • Dispensing • Must be very accurate – independent drops important • Do not dispense liquid until ready to mix cement • Do not store in refrigerator • Carboxyl groups bond to calcium in tooth • Water hardening cements • Zinc oxide or glass powder mixed with anhydrous polyacrylic acid • Combined powder mixed with companion liquid (mostly water) • Polyacrylic acid dissolves in water then reacts with ZO or glass

13. Dental cements • Combine one of the three cement liquids… • Eugenol • Phosphoric acid • Polyacrylic acid • With one of the two powders • Zinc oxide powder • Glass powder

14. Most commonly used • Calcium hydroxide • Used as a base/liner under restorations in deep preps • Used as for pulp capping • Zinc phosphate • Used to lute restorations, ortho bands – also used as a base material under restorations • Zinc oxide-eugenol (ZOE) • Chalky and white, used when not concerned with aesthetics. • Obtundant – kind to pulp • Glass ionomer • Used for thermal insulation under restorations, luting agent

15. Zinc Phosphate Cement • Use 1. Lute inlays, crowns, bridges, ortho brackets, etc. 2. Also used as a base material under restorations. B. Related Information When the powder and liquid are mixed, an exothermic (heat-releasing) reaction occurs. To dissipate the heat of this reaction: 1. A large portion of the glass slab must be used during mixing. 2. The powder must be added in small increments. 3. The mixing time must extend to 1.5 to 2 minutes.

16. Zinc phosphate cement/base material Zinc Phosphate Mixing • Set up time is 5-9 min. • Add powder to liquid in small increments

17. Mixing for luting consistency Measure the powder Measure the liquid • “fluff powder” • Fill scoop; do not pack • Divide powder into several small increments • Hold bottle vertically • Dispense correct # of drops of liquid • Add powder in small increments • Should stretch ½ inch

18. Glass ionomer • Use 1. Base, luting agent, restorative material 2. Thermal insulating material in deep preps • Characteristics 1. High strength, low solubility 2. Kind to pulp 3. Chemically bond to tooth structure; release fluoride • Dispensing systems 1. Powder/liquid systems 2. Disposable capsules – mixed in amalgamator 3. Paste/paste systems

19. Mixing for base or luting Higher power/liquid ratio Mix • Measured in same manner • Setting time is ~ 7 min. • Mixing time between 15-30 seconds • Add about ½ the powder at first, then the rest • Mix is determined by ratio set by manufacturer, not “feel” • Clean up with soap and water before cement sets

20. Liners • Used to protect pulp from chemical irritation • Stimulate dentin formation or release fluoride • Considerations: • Do not provide thermal insulation (too thin) • Too weak to support restorative materials or condensation forces (dental amalgam) • Once used under composites to prevent irritation-not much anymore

21. Calcium hydroxide liners and bases • Promote the formation of secondary dentin • Comes as paste/paste system • One is calcium hydroxide, one is salicylate. • Titanium oxide is an added filter • Setting reaction is accelerated by water • Sets very quickly on moist dentin

22. Dycal (Calcium Hydroxide) A. Use Calcium hydroxide may be used in pulp capping and as a base/liner under other dental restorative materials in deep preparations. B. Protective Properties Calcium hydroxide serves as a protective barrier between tooth tissues (dentin and pulp) and acid-containing cements and restorative materials. C. Measuring Dispense small, but equal, amounts on a paper mixing pad D. Mixing Mix thoroughly with the crook of a small, ball-pointed instrument until a uniform color is achieved Mixing should be completed within 10 seconds.

23. Calcium Hydroxide, con’t E. Application Use the tip of the ball-pointed instrument to place the mixed material on the floor of the cavity preparation. Avoid placing the mixed material on walls and margins, and avoid placing it in large amounts. F. Setting The setting time of mixed calcium hydroxide is 2 to 3 minutes on the mixing pad at normal room temperature. The setting time for a pulp capping or base/liner will be greatly decreased in the mouth because of the moisture of dentin.

24. Cavity Sealer Varnishes Copal Varnish • Resins dissolved in a solvent • Painted onto entire cavity preparation • Solvent evaporates, leaving thin resin layer • Used under amalgams • NOT used with composites (interferes with adhesion)

25. Cements as Pulp Protectors

26. Zinc-oxide eugenol (ZOE) Use Protective properties • One of the least irritating dental materials 1. Temporary cement 2. Insulating base under permanent restorations 3. Provide obtundant filling for sensitive tooth • Thermal trauma • Sedative, soothing effect on dental pulp

27. Measuring ZOE Powder Liquid • Use scoop provided by manufacturer • Place 1 scoop of powder onto glass slab or paper pad • Dispense 2 drops of eugenol by holding dropper perpendicular to slab/pad • Drops should not touch powder, but should be near to it

28. Mixing ZOE cement • Hold spatula in “flat” position • Draw about half of powder into liquid • Use small area of mixing slab/pad • Push powder into liquid with quick motion • Continue incorporating small portions of powder • Mix should be complete in 1.5 minutes • Sticky consistency – use for cementing temporary crown • Thick, putty-like consistency – use for base or temporary filling

29. Intermediate Restorative Material Reinforced ZOE IRM • Stronger, less soluble than ZOE • Temp restorations • Intermediate bases • Additives include: • Alumina • Resins

30. Mixing IRM • Measure 2 scoops of powder onto glass slab/paper pad • Place 1 drop of liquid onto slab/pad • Hold spatula in “flat” position • Draw about ½ of powder into the liquid • Use small mixing area; spatulate with quick motion • Continue incorporating powder into the mix by pressing powder into the mix • Mix must be thick, putty-like • Complete mix in about 1.5 minutes

31. Application • Gather IRM into one mass on the mixing slab/pad • May be rolled with fingers to form a ball • Use flat-bladed instrument to carry portions of material to the cavity prep • May dip instrument into excess powder to prevent sticking • Sets up in about 3 – 3.5 minutes • Glass slab may be cleaned with alcohol wipe

32. Temporary Cement Temp Bond Properties • High flow to permit ease of seating restoration • Strong enough to withstand forces of chewing • Allow restoration to be easily removed

33. Temporary Cement Measuring Mixing • Two tubes • Catalyst • Base • Squeeze equal lengths of material onto pad • Mix together in 30 sec. • Homogenous color • Should form a string when stretched from mixing pad • Apply thin layer to restoration, sets in 2 min.

34. Temporary Crown • Temporary crown • Crown prep leaves an exposed tooth which can be painful. • Temp crowns usually made of plastics and formed in mouth. • Also made of metal or plastic formed outside of mouth. • Temporary cement used to apply temp crown. • Placed at crown prep appointment, lasts few days or weeks.

35. How Temporary Restorations are used: • Remove all or part or decay from tooth, then allow pulp to heal before determining treatment. • Patients with many carious lesions (more than 10) to make the oral environment noncariogenic • A temporary filling on an “open” tooth in endodontic therapy.

36. Exposure controls/personal protection with Eugenol • Respiratory protection: In well ventilated areas respiratory protection is not normally required. In confined, poorly ventilated area respiratory protection may be necessary • Hand protection: Wear impervious gloves • Eye protection: Wear eye protection. e.g. Safety glasses/goggles

37. What you need to know to stay safe • As with most dental materials …read the label and look for hazardous or toxic products in the materials • Be aware of potential for allergic reactions • Follow OHSA exposure limits

38. Generic and brand names of base materials • Bases: • Shofu base cement (Shofu) • Ketac bond capsules (ESPC) • Zinc Phosphate (Mizzy) • ZOE B&T (Caulk)- Eugenol-containing material

39. Generic and brand name Liners • Liners:Heavy filled glass ionomers: • Fuji IX GP in capsule or powder/liquid form. • ESPE: provisional filler, larger non-stress-bearing build ups • SHOFU • Light cured resin modified glass ionomer • Vitre-bond (3M) • Fuji Lining Cement LC (G-C)

40. Group Activity • Divide up into 5 groups – about 4 to a group • Discuss the case study your group is given, and answer these • questions: • What material will you select for your patient? • Why did you select that material? • How will you mix/apply the material? • How long would you expect the material to last?