Dental Cements

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Dental Material II

lecture # 9

"Slide "2 It is a group of material that has many applications in dentistry some of cements we talked about like GIC. Some of them are used to protect the pulp (such as Liners, bases or varnishes). Some of them are for cementing crowns or bridges (we call them luting agents) others can be also used as restorations temporary or permanent like GIC and ZnO/ eugenol. Or we can use them as surgical dressing. If the patient had surgery in his gingiva, you need to place a dressing until healing occurs to prevent any irritation or pain for the patient like when you dress your wound with some .antiseptic agents

"Slide "3 They are summarized in a table. Each application, and the .cements that can be used for that application

"Slide "4 One of the uses of cements in dentistry is to protect the pulp. Irritation of the pulp can result from caries, chemicals in restorative material, cavity preparation (because we use hand piece that are rotating. this can generate heat which can damage the pulp) .and thermal conductivity of metal restorations This irritation can be transient or can be so sever (can lead to .pulpitis which is irreversible

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A liner is placed when you are near the pulp usually in a very thin layer up to 0.5 mm. If you need more support or more isolation of the pulp, you can use a base which is .applied in a thicker layer up to 0.75 mm

"Slide "6 Cavity varnishes are applied in thin layers (usually more than one layer) that placed on the floor and walls of the cavity to seal .dentinal tubules and minimize sensitivity and microleakage This material is made from two components: resin and a solvent .((alcoholic solvent When you apply this liquid the alcoholic solvent will evaporate and a layer of resin will remain. This layer of resin will go into the dentinal tubules and will cover the floor and the walls and cause this .insulation

"Slide "7 When it is applied, it should be in a thin layer. We should allow it to dry. After few seconds we add another layer just to make .sure that we cover all the walls and the floor It will reduce staining, reduce microleakage and it will cause sealing .of dentinal tubules "Slide "8 They are supplied in a bottle containing this liquid and usually it is called Copal Varnish because it is based on a resin called Copal Resin. You apply it using a very small brush to the walls and floor of .the cavity

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Usually along with this bottle they supply it with another bottle that contains the solvent because with time alcohol might evaporate a little pit and the varnish becomes too viscous so you can dilute it by .adding more solvent

"Slide "9 Mostly not a lot of people use varnishes anymore. The problem is that they are soluble (they can wash out quickly) and leave space .behind them so largely they have been replaced by bonding agents

"Slide "10 Another material for protecting the pulp Liners (Calcium hydroxide & ZnO/E (type IV The most commonly used Liner especially before (now we have .substituted it with another Liner) Calcium hydroxide ZnO/E has many types according to its strength and application. Some are more viscous than others, some are stronger than others and some are used as temporary materials, fillings material, bases .and liners We use them as liners to protect the pulp and more commonly it is .(used for procedures (direct and indirect pulp capping

Indirect pulp capping: If you drill a cavity very close to the pulp, a thin layer of dentine that is carious or you are not sure If It is free of caries and you don't want to remove it because if you remove it you will expose the pulp. So we leave that layer and we apply this .Calcium hydroxide on top of it
Calcium hydroxide has certain property including high PH and it is antibacterial so if there is caries with bacteria it will kill bacteria .and stop caries from progressing
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Direct pulp capping: the pulp is exposed so you have to drill your cavity clean the walls and instead of immediately going to RCT and .removing the pulp we can treat it The exposure need to be small "pin point site", clean environment .and no contamination Calcium hydroxide maybe applied as a dressing and because it is high PH and antibacterial it can also stimulate dentine formation (This will close the exposure site, form like a bridge and isolate the pulp .(again This Calcium hydroxide can be supplied as two paste or one paste "chemical cure or light cure". Two paste systems has a Base and Catalyst. The base is white in color and the catalyst is light brown. You mix them together to get one homogenous and then you apply it on the pulp or where the pulp is "you never apply it on the walls ." because there is no pulp there The base contains Calcium phosphate, Calcium tungstate, zinc oxide etc The catalyst contains Calcium hydroxide and zinc oxide. The Light cure cement has photo initiator. It has UDMA and a filler. Both have similar properties and similar applications but the Good in this light cure cement is that instead of waiting for 3 or 4 minutes u can cure .it in a few seconds and it will be hard

"Slide "11 This is an example of pulp exposure where Calcium hydroxide .was replaced a thin layer is applied

"Slide "12 :Properties of Calcium hydroxide

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(Alkaline PH (It can stimulate dentine formation * (setting time is 2-7 minutes (usually less than that * It has a weak compressive strength (It is one of the problems of * (Calcium hydroxide (It dissolve easily Now we use a different material for direct pulp capping (It is called MTA). Another disadvantage is weak strength, when you condense Amalgam on top of It, It might start to break because it is weak so usually what we do is after applying Calcium hydroxide we apply another layer of a different liner like Resin Modified Glass Inomer .cement or ZnO/E

"Slide "13 (Another Liner we call it Low strength Base (ZnO/E type IV For pulpal protection in deep cavities. It is a weak material but the advantage is that it has a sedative effect (It can reduce pain because of the Eugenol). If the patient comes and says "I have pain on hot, cold, air and sweet" So It is a good idea to put ZnO/E .underneath your filling because it will minimize this pain They have therapeutic uses But the problem is It is applied in thin layer so It is weak and really not provide a good insulation of the .pulp

"Slide "14 This is an example of ZnO/E cement . We can place High .Strength Base on top of it

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High Strength Base is usually applied in a thicker layer and it is not a flowable material (It is more viscous) so it can provide .support for restoration and good insulation "Slide "16 ?What materials can be used as base A variety of materials one of them is GIC, Resin Modified GIC (And reinforced ZnO/E type III (It is stronger than type IV We need the material to be strong enough and this strength needs to develop quickly because we need to put our restoration without .waiting for 10 minutes for the material to become strong

It needs to have low thermal conductivity because we want it to act as an insulator. And I don't want it to be too flexible or too rigid. So ." "Moderate elastic modulus

Luting agents These materials are used for cementation of crowns and bridges. :They need to have certain features We want them to flow very well inside the crown so that they can * cover all surfaces of the tooth and prevent any microleakage "good ."wettability Good flow ** (Thin film thickness (max. 25m ***
If it is too thick, it will prevent proper sealing of restoration and excess might remain which may wash out and cause irritation and caries. These materials should flow easily so they are mixed to a ."flowable mix "low viscosity "Slide "19
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This represents a crown and a tooth that was drilled. We took an impression, sent it to the lab and they made the restoration using Lost Wax .Technique We use luting agents to attach this crown to .the top of the tooth

"Slide "20 We mix the cement; apply it inside the crown (we have to place enough material inside the crown to cover all surfaces inside .(the crown

Restorations Another use of cements just like GIC, It can be used as permanent restoration in class (V) cavities. Usually they have low strength &high solubility. They can be used as a restoration in areas that are .not subjected to stress
Some of these restoration materials can be used as temporary :restorations in certain cases .If time is insufficient to place permanent restoration * between visits in cases of endodontic treatment, crowns and** .inlays It is a common practice in private clinics to leave the tooth open with no restoration They say we want all bus and gases to be released this is WRONG The temporary material needs to be strong enough so that it can last for one week, two weeks and sometimes a month. And at the
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same time you dont want it to be too strong so that when you .remove it, it will not take a long time If the patient is in pain "stimulated by cold, heat" you can place temporary material until healing occurs and then call the patient for . a permanent filling BUT this is not a common practice NOTE: even your patient comes with pain don't place temporary filling if you can place a permanent one because permanent .restoration can seal your cavity mush better than temporary filling Intermediate Restoration Material (IRM) is a common temporary filling. You mix the powder with the liquid and the material needs to .be viscous enough so that u can place it in the cavity

THE END

Done by : Duha Yunus

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I know I'm waiting Waiting for something Something to happen to me But this waiting comes with Trails and challenges Nothing in life is free

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