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Cements used for All- Ceramic restorations

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Introduction
Bonding to ceramic restorations The increased use of ceramic veneer & inlay/onlay in dentistry and the fact that porcelain-fused-to-metal restorations sometimes fracture and need to be repaired have increased the interest in how to bond composite to ceramic surfaces. A strong resin bond relies on micromechanical interlocking and/or chemical bonding to ceramic surface which provides high retention and prevents microleakage and increases fracture resistance of the restored tooth and restoration. (Resin-Ceramic bonding) :1. Mechanical retention:Common treatment options are grinding, abrasion with diamond rotary instruments, air borne particle abrasion with aluminum oxide, acid etching or combination of any of these methods. 2. Chemical retention: Silane: Silane is one of the most well-known compounds capable of forming bonds to ceramic surfaces. The bonding mechanism consists of both covalent and hydrogen bond formation. During the bonding process, the silane molecule orients itself parallel to the ceramic surface. So the ceramic surface becomes hydrophobic and organophillic. The hydrophobicity protects the ceramic surface from hydrolytic degradation, while the organophilicity facilitates resin wettability. Bonding to silica- based ceramic:a.Mechanical bond : Acid etching with Hydrofluoric acid etching is only possible with SiO2 based ceramics or glasses according to the equation reaction. 6H2 F2 + 2 SiO2 2H2 SiF6 + 4 H2O b. Chemical bond : Application of silane coupling agent: (methyl silane) Silanes are bifunctional molecules that bond silicon dioxide with the OH groups on the ceramic surface. They also contain a functional group that co polymerizes with the organic matrix of resin.

Composition: Bonding to high strength ceramic (non etchable ceramic): Pyrosil pen: One major component diacrylate or Urethane Photo-initiator-Camphorquinone oligomer diluted with dimethacrylate monomers. The advantage is that it made it easier to use for chair-side applications. Silanated silica or Glass. Application of the PyrosilPen-Technology had been researched on ZrO2-based Bonding to densely-sintered aluminum oxide ceramic: (Procera All-ceram) Initiator activator systemperoxide amine ceramics although further researcher is required before the Pyrosil PenSelf cured, powder liquid system, Mechanical bonding : Air borne particle abrasion 50 4-META um Al2o3. Technology can be used as an acceptable method to enhance bonding of ZrO2 Self-cured, 2-paste system(phosphonate cement) Bis-GMA Resin, Silanated quartz filler Tribochemical surface treatment with the rocatec system found to have a superior to resin cements. Light cured, 1 component system Bis-GMA. effect than other treatment. Dual-cured, 2 component system Bis-GMA or UrethaneDMA Chemical bonding: Also combination of air particle abrasion and bonding to resin Plasma spray technique: Photo-initiator- Camphorquinone cement containing phosphate monomer (MDP) as in Panavia F or Panavia 21 or Another form of silicoating uses a plasma spray technique to deposit a siloxane phosphoric acid methacrylate as in (Rely X Unicem) found to be the most coating on ZrO2. successful through chemical bond between aluminum oxide and phosphate GLASS IONOMER CEMENT monomer adhesive functional group. Bonding to zirconium oxide based ceramic: To improve mechanical bonding. Surface grinding: Grinding using abrasive paper or wheels (SiC or Al2O3), particle air-abrasion using Al2O3 or other abrasive particles ranging in size from 50 to 250 um, and grinding using a diamond bur. Heat treatment: The optimal temperature for conditioning the substrate is 1000 C, for a period of 10 minutes. The action of the hot etching solution is basically a corrosioncontrolled process. It selectively etches the zirconia. Composition of Conventional glass ionomer cements Powder The powder is an acid-soluble calcium fluoroaluminosilicate glass Silica - 41.9% Alumina - 28.6% Aluminum fluoride - 1.6% Calcium fluoride - 15.7% Sodium fluoride - 9.3% Aluminum phosphate - 3.8% Liquid Polycarboxylic acid copolymer concentration of about 40 to 50% and tartaric acid(>5%)

Composition of Hybrid ionomer cements or resin-modified glass ionomers or dual-cured GIC: Powder: radiopaque fluroalumina-silicate glass. Liquid: modified polyacid with HEMA (hydroxyethyle methacrylate) Setting reaction : Polymerization: initial setting.(light or chemical cure) Acid-bace reaction: maturing process, final strength. Heat released from the polymerization reaction. Properties: 1.Biologial : mild irritant effect on pulp and anticariogenic by release of fluorid. 2.Film thickness: 24m. 3.Solubility: 1.5% after 24hrs (must be coated with varnish). 4.Strength: *Compressive strength 90-240MPa after 1hr. *Tensile strength 14-24MPa. 5.Bonding: chemical bond to enamel and dentin reaction of polyacrylic acid with calcium and phosphate. 6.Optical: Conventional GI opaque but Modified GI translucent . 7. Setting time: Mixing time: 15 seconds Setting time: 2 minutes Working time: 2 minutes Total time: 4.5 minutes at 23 C Resin-reinforced glass ionomer cements are well suited to luting high-strength ceramic crowns due to their excellent mechanical properties and aesthetic appearance. They offer easy handling, low solubility in the mouth high adhesion, low linear expansion and a superior marginal integrity

The advantages of these cements include: 1-high strength 2-low oral solubility 3-high micromechanical (and possible chemical) bonding to prepared enamel, dentin, alloys, and ceramic surfaces. 4-Able to reduce fracture of the ceramic structures 5-Virtually insoluble in oral fluid

Bonding of Ceramic Prostheses: The inner surfaces of ceramic are etched and a silane coating may be applied before cementation to achieve optimal retention. To assist the clinician in selecting the proper shade of cement, some systems provide water-soluble try-in materials with the same shades as the cements. The material is applied, and the prosthesis is seated and examined for its aesthetic appearance then, the residual try-in paste can be rinsed away with a water spray. This process can be repeated until reach aesthetic appearance. The cementation process is then completed using cement with the same shade after cleaning the try in material from the preparation and the prosthesis. Adhesive Resin Cement Definition of Adhesive resin cement: Are a group of dental cements composed of polymethyl methacrylate or dimethacrylate produced by mixing an acrylic monomer liquid with acrylic polymer and mineral fillers. Classification of Adhesive Resin: Class-1: Self Cured- 2 component systems Class-2: Light Cured- 1 component system Class-3: Dual Cured- 2 component systems Composition: One major component diacrylate oligomer diluted with dimethacrylate monomers. Silanated silica or Glass. Initiator activator system- peroxide amine Self cured, powder liquid system, 4-META Self-cured, 2-paste system(phosphonate cement) Bis-GMA Resin, Silanated quartz filler Light cured, 1 component system Bis-GMA or Urethane Photo-initiatorCamphorquinone. Dual-cured, 2 component system Bis-GMA or UrethaneDMA Photo-initiator- Camphorquinone

Resin cements
Resin cements were introduced in the 1950s, low filler content unfilled resin (Resin only) In the early 1970s, a resin composite was introduced as a crown and bridge cement. Resin composite Cements Classifies resin cements According to curing mode as Class 1-self-cured materials Class 2-light-cured materials Class 3-dual-cured materials 1- Light-Cured Cement: Cement that contains a photoinitator that is only polymerized by exposure to light. These cements are particularly effective for ceramic or composite veneers. 2-Self-Cured Cement: Polymerization occurs in the absence of light. This allows for the cementation of metallic-based restorations or thicker and more opaque ceramic restoration 3-Dual-Cured Cement: The cement is versatile because it contains both the photoinitator for lightcuring and the chemicals for self-curing Composition: Resin matrix and filler inorganic particles. Composition is usually a mixture of dimethacrylate monomers, inorganic fillers (60% to 70% by weight), and initiator. The filler fraction may vary between 30% and 66% by volume and contains silanated radiopaque glasse such as barium, strontium, or zirconia, along with silica particles. The aliphatic amines (such as 2 (dimethylamino) ethyl methacrylate, DMAEMA) functions as accelerator of free-radical production. Applications: Self-cured and dual-cured materials can be opaque or translucent, and those indicated for cementation of ceramic restorations are usually provided in several shades. Light-cured materials are indicated for bonding of laminated ceramic veneers (esthetic cements) or orthodontic brackets

Bonding to pressed glass ceramics: A. Leucite reinforced feldspathic porcelain: (IPS Empress) Mechanical bonding: Acid etching : by 9% HF applied for 60 seconds will be successful. Chemical bonding: Methyl Silane coupling agent B. The lilhium-disilicate glass-ceramic IPS Empress 2: Mechanical bonding : 10% (HF) acid will results in change in the surface morphology, increase in the surface area which favored infiltration and retention of adhesive materials. Chemical bonding: Methyl silane coupling agent .

Selective infiltrative etching: Selective Infiltration Etching (SIE) method used principles of heat-induced maturation and grain boundary diffusion creating inter-grain nano-porosity where the adhesive resin-composite can infiltrate and interlock to transform non retentive Zirconia surfaces into a highly retentive surface, resulting in improved Zirconia-resin bond strengths. Laser surface treatment: The laser treatments, such as erbium: yttrium- aluminum- garnet (Er: YAG) Er: YAG and neodymium:yttrium-aluminum-garnet (Nd: YAG) laser, but produce less durable bond. Chemical bonding: Traditional silane chemistry is not truly effective with ZrO2.

Glass ionomer cement is a tooth colored material, introduced by Wilson & Kent in 1972. .Material was based on reaction between silicate glass powder & polyacrylic acid. They bond chemically to tooth structure & release fluoride for relatively long period. Classification: Luting crowns, bridges and orthodontic brackets *Conventional glass ionomer cements (low- and high-viscosity *Resin modified glass ionomer cements (conventional with addition of HEMA) Setting reaction Conventional glass ionomer cements: The setting reaction is an acid-base reaction between the acidic polyelectrolyte and the aluminosilicate glass..Cored structure of unreacted glass surrounded by silica gel embedded in matrix of cross-linked polysalt-hydrogel of calcium and aluminum.

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