DENTAL CEMENTS • Materials used as base are:

o Zinc Oxide Eugenol (rapid setting)

• a substance that serves to produce solid union o Zinc Phosphate
between two surfaces. o Polycarboxylate
• Materials of multiple uses including o Zinc Silicophosphate
restorations, luting and therapeutic. o GIC (glass ionomer cement)
• They are generally materials of comparatively Cements
low strength, but have extensive use in dentistry.
Liners • A substance that serves to produce solid union
between two surfaces.
• Material applied to the inside of the walls of a o Cements attach restorations to the
prepared cavity. surface of the tooth. For example,
o For example, a class I cavity will consist before placing the jacket crown on the
five walls (buccal, lingual, mesial, distal prepared tooth, cements are applied so
and pulpal wall) that it will stick the crown to the surfaces
o The liners are applied to these walls to of the tooth.
protect the pulp of the tooth. • Materials used as cements:
▪ Because when doing a cavity o ZOE
preparation there is a tendency o Zinc Phosphate
for us to open the dentinal o Zinc Polycarboxylate
tubules and if liners are not o GIC
applied to the walls of the o Zinc Silicophospate
cavity, there will be a possibility
that the materials placed on the CLASSIFICATION OF CEMENTS
tooth is harmful to the pulp as
some of these materials have I. According to Setting Reaction
acid content.
• Acid-Base Reaction Cements
• For protection and insulation of the surface of
o Formulated as powder (base) and liquid
the prepared cavity
(acid)
• Materials used as a liner are the following:
o on mixing the two, an acid-base reaction
o Cavity Varnish
takes place resulting to a viscous paste,
o Calcium Hydroxide
which hardens to a solid mass
o GIC (glass ionomer cement)
• Polymerizing Cements
Bases
o Set by polymerizing reaction which may be
• A cavity lining agent used beneath permanent light activated (needs light curing unit) or
restorations to enhance recovery of injured chemically activated (mixture of the powder
pulp or to protect it from: and liquid)
o thermal shock o Example: Resin Cements
o galvanic shock • Dual Cure Cements
o mechanical trauma o Combination of the acid-base reaction
o microleakage, and cements and polymerizing cements.
o toxic substances in some restorations o Set by acid base and any one of the
▪ Bases are placed beneath the polymerization (light activated or chemically
filling materials to protect the activated) mechanisms
tooth from toxic substances of • Tricure Cements
filling materials. o Utilize all three mechanisms for hardening
▪ Depths in restoration: (acid-base, polymerizing and dual cure)
• Depth a II. Based on Application
• Depth b
• Type I Luting Agents
• Depth c
o Type I fine grain for cementation
• Depth d
o Type II medium grain for bases,
▪ Bases are only applied in depth
orthodontic purpose
b, c and d.
 • Type II Restorative Applications Obtundent (Pulp • Zinc oxide eugenol – it
• Type III Liner or Base Application Therapy) has sedative effect
III. ISO Standards that heals the pulp
Liners • Calcium hydroxide
• ISO 9917-1:2003 Water Based Cements-Part 1:
Root Canal Sealers • Zinc oxide-eugenol
Powder/Liquid Acid-Base cements
• Zinc polycarboxylate
• ISO 9917-2:1998 Water Based Cements-Part 2: (combined with gutta
Light-activated cements percha)
• ISO 3107:2004 Zinc Oxide/Eugenol and Non Core Build Up • Resin modified GIC
Eugenol cements (Absence of toot • Metal modified GIC
structure of clinical • Composites
• ISO 4049:2000 Polymer-based filling, crown)
restorative
and luting materials
REQUIREMENTS OF A GOOD CEMENT
USES OF CEMENTS
• Easy to manipulate
Function Cement used • Biocompatible
Final Cementation • Zinc phosphate • Durable
(Fixed bridge, • Zinc silicophosphate • Should have a low coefficient of thermal
crown, inlay, onlay) • EBA cement expansion
• Zinc polycarboxylate • Should be dimensionally stable
• Glass ionomer • Extensive suitability
• Resin cement • Should have sufficient strength to adhere to the
Temporary • Zinc oxide-eugenol tooth (adhesive strength)
Cementation • Non-eugenol zinc
(Temporary oxide SILICATE CEMENTS
crowns/provisional
crowns) • Introduced in 1878 by Fletscher as an anterior
Bases • Zinc phosphate esthetic filling material
(Before putting the • Reinforced zinc oxide - o For pasta
final filling eugenol • Translucent and resembled porcelain in
materials) • Zinc polycarboxylate appearance
• Glass ionomer • Initial esthetic was satisfactory but over a period
• Zinc oxide eugenol of time silicates degraded and stained
• Calcium hydroxide o Because it is soluble in the oral fluids.
Long Term • Glass ionomer • Average life is 4 years
Restorations • Compomer • Anticariogenic because of Fluoride
(combination of o Prevents formation of caries
composite and glass • Most soluble among the tooth-colored
ionomer) restorative materials so that the fluoride ion will
• Metal modified GIC be released and serve its purpose
• Very acidic: 2.8 pH at the time of insertion
Temporary and • Zinc oxide-eugenol
o That is why when using silicate cements,
Intermediate • Reinforced zinc oxide -
liners need to be applied first on the
Restoration eugenol
walls of the prepared cavity.
• Zinc polycarboxylate
• Use as final resto material for surfaces that don’t
• Glass ionomer receive direct masticatory force such as class 3,
Pulp Therapy • Calcium hydroxide (act 5 and lingual and occlusal pit
(Depth c & d) as a liner) – placed • Never use on the occlusal surface
under depth c & d to • For ideal depth cavities (depth a): paint varnish
trigger the formation into the prepared cavity before silicate
of tertiary dentin via • For deep seated cavities: apply liner to prevent
irritation of the pulp.
 chemical irritation are placed on the bucco-pulpal line angle
• Never use silicate when the cavity touches the and lingu-pulpal line angle.
gum because it is very soluble to the oral fluid • It takes 24-48 hours before polishing the tooth using
o Never use this in class V caries a bur.
• Setting time: 3-8 minutes
Liquid (like ZnPO4) Factors that Control the Setting Time
• H3PO4 – ortho phosphoric acid ▪ P:L ratio
• can pass thru dentinal tubules ▪ Temperature of the mixing apparatus
• AlPO4 ▪ Humidity of the room
• ZnPO4 ▪ Rate of mixing the powder- particle size of the
• MgPO4 powder
• H2O
Properties of Silicate Cements
Manipulation
• Solubility rate: 0.7%
• Apparatus: • Compressive strength: 26,000psi
o Plastic spatula • Tensile strength: 500 psi
o glass slab/oil impervious pad • Hardness: 70KHN
• Get 1 scoop of powder and divide the powder into • pH: 2.8 very acidic
6 equal parts
• Incorporate one increment of powder at a time into ZINC PHOSPHATE CEMENT
the liquid.
o Apply liquid near the area of the powder •Oldest of the luting cements
• Mix it in rotatory motion to dissolve the powder and •Other name is Zinc oxyphosphate
fold it to check if there’s any unreacted powder. •Available as powder and liquid
• Apply pressure to dissolve it easily. •Supplied in shades of
• To check if the mixture is in correct consistency: tap o Yellow
and raise the spatula slowly o Grey
• There should be no string like projections that goes o golden brown
with the spatula and the surface of the mix should o pink
be moist. o white
• The mixture should be shiny in appearance. • Uses are:
• Consistency: Heavy Putty o Luting of restorations
▪ Inlays
Consideration ▪ Crowns
▪ Fixed dental prostheses
• Work on narrow working area to prevent air- o High strength bases
trapped bubbles (as air-trapped bubbles weaken o Temporary restorations
the set) and to get a correct consistency of the mix o Luting of orthodontic bands and
• Never use a stainless spatula. Once incorporated to brackets
the mix, it will remove sulfide ions and it will lead to • Classification
discoloration of the restoration. o Type I: fine grained for luting
• Silicate cements don’t have adhesive property/ ▪ Consistency is thick and creamy
chemical bonding therefore mechanical undercuts o Type II: medium grained for base and
are needed temporary restoration
o Mechanical undercuts are being placed ▪ Consistency is thick and doughy
inside the prepared cavity on the line Composition
angle.
o The line angles are the joining of two • Powder
walls. o Zinc oxide – 90.2% as principal
o For example, on a class I cavity constituent
preparation, the mechanical undercuts o Magnesium oxide – 8.2% aids in
 sintering o Pre-cool in a ref
o Other oxides (like bismuth trioxide, ▪ Wipe the moist before you use it
calcium oxide) – 0.2% improves o Pat the glass slab dry before mixing
smoothness of mix
o Silica – 1.4% filler, aids in sintering
• Liquid ZINC POLYCARBOXYLATE CEMENT
o Phosphoric acid – 38.2% reacts with zinc • Canadian biochemist Smith developed the first
oxide polycarboxylate cement in 1968 by substituting
o Water – 36% controls rate of reaction the phosphoric acid of zinc phosphate cement
o Aluminum phosphate – 16.2% buffers, with polyacrylic acid.
to reduce rate of reaction • Became the first cement system developed with
o Aluminum – 2.5% potential for adhesion to tooth structure
o Zinc – 7.1%
Available as:
Manipulation
• Powder and liquid in bottles
• Spatula used: stainless steel
• Water settable cements
• Mixing Time: 1 min. 15 secs.
• As pre-capsulated powder/liquid system
• Powder to Liquid ratio: 1.4gm/0.5 ml
• Dispense the powder in a glass slab and place 2 Applications
drops of liquid near the powder.
• Divide the powder into 6 small parts. Bring the 1st • Primarily for luting permanent restorations
part of the powder into the liquid and mix it using • As base and liners
brisk circular motion. • Used in orthodontics for cementation of bands
• Each increment is mixed for 15 to 20 seconds and • Also used as root canal fillings in endodontics
used large area to dissipate exothermic heat.
• To check for the correct consistency, 1 inch string COMPOSITION
will form between the spatula and the glass slab.
• Powder
Advantages 1. Zinc oxide – basic ingredient
2. Magnesium oxide – principal modifier and also
• Long track record with reliability aids in sintering
• Good compressive strength 3. Oxides of bismuth and aluminum – small
amounts
Disadvantages 4. Stannous fluoride – increases strength, modifies
setting time and imparts anti-cariogenic
• No chemical adhesion (relay on mechanical properties
undercuts)
• Liquid
• No anticariogenic property (cannot prevent 1. Aqueous solution of polyacrylic acid
caries formation)
• Pulp irritation Manipulation
• Poor esthetics
• Conditioning
Factors that Alter the Setting Time o The tooth structure should be meticulously
clean for proper bonding
• P:L Ratio: o To clean the surface, 10% polyacrylic acid
o increase liquid, weaker set, longer solution followed by rinsing with water or 1 to
setting time 3% hydrogen peroxide
o increase powder, faster setting time • Proportioning
• Speed of Manipulation: slower rate of adding o 1.5 parts of powder to 1 part of liquid by
powder to the mix, longer setting time weight
• Temperature of Mixing Apparatus: o Dispense one scoop of powder on a mixing
o Ways to cool the slab: wash it in a pad. A drop of liquid is placed near the
running water, powder.
 o The powder is mixed into the liquid in two Classification According to Usage
increments with the use of a plastic spatula.
Forcibly mix powder and liquid. • Type I Conventional ZOE
o Mixing should be completed within 60 o Used as temporary cementing medium
seconds or less and the restoration must be o Dispensing Form: 2 paste form
seated within 2 minutes from the start of • Type II EBA (ethyl benzoic acid) Alumina ZOE
mixing o EBA -60%, Aluminum – 34%, ZOE –
o The consistency must be creamy and must 60.5%
form a “1-inch string” o Used as permanent cementing medium
o The mixed material must be placed while the o Dispensing Form: Powder and Liquid
cement surface appears glossy; beyond that • Type III Polymer Modified ZOE
tie adhesion is reduced or lost. o 20% polymethyl methacrylate added to
• Final setting is from 7 to 9 minutes ZnO
• Clean up with water and should be done as soon as o Used for temporary restoration and
possible. base for permanent restoration
▪ ZOE is used for temporary
Advantages restoration in cases where
patient is in doubt whether
• Comparatively less irritating to the pulp he/she felt pain or not.
• Chemical bond to tooth structure ▪ For permanent restoration, ZOE
Disadvantage is placed beneath the final
feeling material (amalgam)
• Limited fluoride release when compared to GIC • When you use ZOE for
permanent restoration,
ZINC OXIDE EUGENOL CEMENT (ZOE) amalgam must be used
as the final filling
• These cements have been used extensively in material as composite
dentistry since the 1890s are not compatible with
• They are cement of low strength ZOE
• Least irritating of all dental cements and are o Dispensing Form: Powder and Liquid
known to have an obtundent effect on exposed • Type IV ZOE liner
dentin o Inhibits polymerization of resin, never
o It heals the pulp upon the placement of use this with composite resin unless you
ZOE will use the non-eugenol ZOE
o Zinconol – a good brand of ZOE next to o Dispensing Form: Single Paste Form
IRM which is made by the Dentsply
• A dental cement used chiefly in temporary Manipulation as Base Material
fillings, thermal insulating bases, and root canal
fillings. • On a glass slab, place a scoop of powder on one
• Some formulations are used as luting agents for corner, and then one drop of liquid is dispensed
the permanent cementations of gold inlays and near the powder. Be sure to hold the dropper
crowns. perpendicular to the slab. The liquid should not
Uses touch the powder.
• The powder is divided into 2 big parts, one of
• Temporary and permanent cementing medium which is divided again into 2 smaller parts. The
• Liners biggest part is now brought to the liquid
• Luting agent o In total there’s 3 parts of the powder (1
• Base big part and 2 smaller parts)
• Root canal sealer • Spatulate the powder and liquid in a rotatory
• Dispensing form: powder (ZnO) and liquid motion until all the powder is incorporated with
(Eugenol) the liquid. Then a folding motion is used.
• Continue to incorporate small portions of the
powder deliberately “pressing” the powder into
the mix with the spatula. Use firm pressure with
 the flat surface of the spatula when GLASS IONOMER CEMENT
incorporating powder
• The mix should be completed in 1-1.5 minutes at • Are adhesive tooth colored anticariogenic
the end of which the mix should be doughy or restorative materials which were originally used
putty in consistency, smooth and free of lumps. for restorations of eroded areas (class V caries)
• Enough powder has been incorporated for a • The first usable glass ionomer system was
base consistency when the mix “flakes” from the formulated in 1972 by Wilson and Kent and was
spatula pressing on the cement. known as ASPA (alumino silicate polyacrylic acid)
• Gather the cement into one mass on the slab. To • The powder is a type of glass and the setting
check correct consistency for a base, the cement reaction and adhesive bonding to tooth
structure is due to ionic bond
may be rolled to a rope-like structure without
adhering to either the slab or the cement • The GIC adheres to the prepared cavity even
spatula. without mechanical undercuts
• Woodson’s plastic instrument is used to carry • Often known as biomimetic material, because of
the cement to the its similar mechanical properties to dentin.
cavity preparation. Uses:
Using the club end of • Anterior esthetic restorative material for
the spatula cut a class 3 cavities
portion of the mix and • Restorative material for eroded areas and
place into the cavity, class 5 restorations
to press or condense • As a luting agent for restoration and
the mix into the cavity orthodontic brackets
use the smooth end of • As liners and bases
the plugger.
• For core build up
o The
• To a limited extent as pit and fissure
Woodson’s
sealants
plastic instrument is made of metal.
• Intermediate restorative material
Manipulation as Luting/Temporary Cement
COMPOSITION
• If the ZOE will be used as luting or temporary
Powder
cement, the consistency must be thin and
creamy 1. Fluoro- Silica Alumina Glass – anticariogenic and
• You have to consider the final luting cement that makes cement translucent
will be used. For example, if you are going to Liquid
cement an all-ceramic crown then an ordinary
1. Aqueous solution of polyacrylic acid and
ZOE cannot be used, instead use a non-eugenol
copolymer – chemically bonding of these two
ZOE
components is the reason for a material to adhere
Properties
to tooth structures.
2. Tartaric Acid – improves the handling
characteristic by increasing the working time and
shortening the setting time
3. Itaconic Acid – decreases the viscosity and
reduces the setting time
4. Water with Citric/Maleic Acid – removes smear
layer for better adhesion

Classification According to Usage:

• Type I: cementing/luting agent
• Type II: restoration for class 3, 5 and 1 (buccal
and lingula pit)
• Type III: liners, pit & fissure sealant
 • Type IV: Pit and fissure sealant o Indications: class 3 & 5 cavities,
• Type V: Luting for orthodontic purposes microcavities under direct masticatory
• Type VI: Core build up material forces and core build up
• Type VII: High Fluoride releasing command set • When using GIC, the tooth involve must be
GIC properly isolated by using a cotton or rubber
• Type VIII: GIC for ART (Atraumatic Restorative dam assembly.
Technique) Type III: liners and bases (pit & fissure sealant)
o ART is a procedure where the decayed
• Base – under composite
tooth will be restored without using
restoration and its called
highspeed handpiece and bur, instead
intermediary base
spoon-shaped excavator will be used.
• Increments: 3
• Type IX: Geriatric and Pediatric GIC
• Mixing Technique: add
powder to liquid in one
Type I: cementing/luting agent
portion (use mixing pad)
• Have a lower • Mixing Time: 30- 45 seconds
powder/liquid ratio • Characteristics of a proper mix: use while glossy
• And a smaller particle size • Setting time: 2-3 minutes
• GIC as a Luting Agent • GIC as a Liner
o Powder particles o For class B cavities
should be smaller. o Stronger bind to the pulp
It should measure o With composite, acid etch the enamel to
less than 20um for make the enamel surface porous = resin
thin mix of the tags are formed for the retention of
cement composite
o Thinner mix better • GIC as a Sealant
cementing action o Weaker, resin sealants are stronger than
o Increments: 3 GIC
o Mixing Technique: o Use when there is a tiny opening
add powder to ➢ Fuji 1 – for cement
liquid in one ➢ Fuji 2 – for restoration
portion (use ➢ Fuji 3 – for liner or base
mixing pad and
plastic spatula)
o Mixing Time: 30- 45 seconds
o Characteristics of a proper mix: use
while glossy
o Setting time: 7 minutes

Type II: Restoration for class 3, 5 and 1 (buccal and

lingual pit)

• GIC as a Restorative Material

o Powder particle size is
20-50um
o Thicker consistency
o The consistency for
esthetic restoration is Why Glass Ionomer cement not mixed on a glass slab?
somewhat doughy ➢ GIC has silicate “GLASS” in its powder and so while
o Mixing time: 45 mixing on glass slab the polyacrylic acid attack the
seconds to 1 minute glass content of glass slab.
o Setting time: 4-5 ➢ This may even alter properties of GIC.
minutes ➢ It may also alter the color of the material (darkens
 the material) a Ca(Oh)2 carrier or applicator (a ball
➢ Instead of using metal spatula and glass slab, use ended instrument)
mixing pad and plastic spatula • Setting time
o Ranges from 2.5 to 5.5 minutes

CALCIUM HYDROXIDE – CA(OH)2

• Relatively weak cement
commonly employed as direct
or indirect pulp capping
agents. (deal with depth c and
depth d)
• Due to their alkaline nature ➢ Do not use cement spatula
they also serve as a protective when mixing Calcium
barrier against irritants from Hydroxide, instead use a ball
certain restorations tip applicator
• A white powder with a slightly bitter alkaline
taste, produced by the action of calcium oxide Calcium Hydroxide
with water • Does not prevent marginal leakage when used as
• Ball tip end applicator is used to place the a liner.
cement on the prepared tooth • Is an effective barrier to the passage of acid.
• pH: 11.5-13, most alkaline • Partially prevents thermal shock. The thicker the
• Uses: layer, the more effective it is against thermal
o Liner shock.
o Root canal sealer o Only true on cases with deep cavity.
o Pulp-capping agent • Compatible with all restorative materials.
• Dispensing Form: • Non- irritating to the pulp when separated from
o Powder form the pulp by dentin.
o Two Paste form – contained in a tube; • Possesses adequate strength to resist forces
base and a catalyst used in placing permanent restorations.
o Single Paste form – loaded in a syringe; Ca(OH)2
injected inside the prepared cavity and
use light curing machine • Bactericidal
• Applications: • Can remineralized tissue
o For direct and indirect pulp capping • Can form tertiary dentin
o As low strength bases beneath
restorations for pulp protection CAVITY VARNISH
o Apexification procedure in young
permanent teeth where root formation • Is a solution of one or more resins which when
is incomplete applied onto the cavity walls, evaporates leaving
▪ Procedure done to close the a thin resin film, that serves as a barrier between
root apex the restorations and dentinal tubules
• Available as: • Natural gum such as copal, rosin, synthetic resin,
o 2 paste system containing base & dissolved in an organic solvent like acetone,
catalyst paste ether or chloroform
o Single paste in syringe form light cured Dispensing Form
system)
• Liquid (like a colorless nail polish)
o Powder form (mixed with distilled
Advantages
water)
• Manipulation • Prevents chemical irritation from acidic cement
o Equal lengths of the two pastes are • Prevents galvanic action
dispensed on a paper and mixed to a • Prevents discoloration under amalgam
uniform color restoration (in the absence of base)
o The material is carried and applied using
 o Class A depth
• Prevents marginal leakage
• For better adaptation of amalgam
Application

• A small piece of cotton wool

held in a pair of tweezers is
moistened with varnish which
is then painted on to the
surface/walls of the prepared
cavity.
o Apply the varnish
twice (2 coating) but
do not reuse the 1st
cotton to prevent contamination of the
rest of the content of the bottle.
• The thin film of varnish is dried with a gentle jet
of air & the process repeated.
Precautions
• Varnish solution should be tightly capped
immediately after use to prevent loss of solvent
by evaporation.
• It should be applied in a thin consistency.
• Excess varnish should not be left on the margins
of restoration as it prevents proper finishing of
the margins of restorations
Contraindications
• Composite resin: the solvent in the varnish may
react with the resin.
• Glass Ionomer: varnish eliminates the potential
for adhesion, if applied between GIC and the
cavity.
• When therapeutic action is expected from the
overlying cement, e.g, zinc oxide eugenol and
calcium hydroxide.