PowerPoint Presentation · Short intraoral cure No over-displacement of wash material 95% of...
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Transcript of PowerPoint Presentation · Short intraoral cure No over-displacement of wash material 95% of...
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`
Accredited Fellow, American Academy of Cosmetic Dentistry
Fellow, International Academy for Dental Facial Esthetics
Member of The American Society For Dental Aesthetics
Diplomat of the American Board of Aesthetic Dentistry
Former Faculty, UCLA Center For Esthetic Dentistry
Speaker, Catapult Education
LEGIONpride.com, Online Training Challenge for Dentists
Entrepreneur, 2 Software Companies, Author/Lecturer, Pro Race Car Driver
Todd Snyder, DDS, FAACD, FIADFE, ASDA, ABADLaguna Niguel, CA
Aesthetic Dental Designs®
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Please Turn On Your Cell Phones
Lecture Handout (iPhone Users)
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Lecture Handout
www.DENTOOLZ.comDigital Handouts, Products I Use & Special Offers
Digital Handouts
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Preparation Design
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Provisionals
• Utilize an accurate preliminary over impression
• Maintain over impression
• Check contacts and occlusion
• Template 30s working time / 30s setting time
Retention form 2.5°-8° Resistance form Prepared tooth 4mm+ tall
Line of draw
0.7 mm - 2.0 mm All Ceramic1.5 mm - 2.0 mm PFMAbove images taken from Glidewell Laboratories
Preparation Design- Zirconia
Zirconia (600mpa-1400mpa)
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Prep counter clockwise Less tissue damage (rotation is rolling on tissue) & faster tooth reduction.
Prep clockwise Tissue removal due to bur rotating opposite direction
rolling on tooth creates less reduction of tooth structure.
Place a single cord after preparing interproximal area
• Bur system that allows for easy depth reduction/identification
• Retention 2.5°-8° (burs have 2°-3°)
• Resistance form (box/grooves)
• Crown height (4mm+)
• Reduction Variations
• Full Gold (0.5mm+)
• PFM (1.5-2mm)
• All Ceramic
• Lithium Disilicate
• Zirconia 0.8mm
K0095 Preparation Kit (Brasseler USA)
Preparation Design
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Margin Refinement E-Statis Prep
(SciCan)
K0095 Preparation Kit (Brasseler USA)
Dent Mater. 2008 Jul;24(7):978-85. doi:
10.1016/j.dental.2007.11.019. Epub 2008 Jan
15.
Bond strength of self-etch adhesives to dentin
prepared with three different diamond burs.
Ermis RB, De Munck J, Cardoso MV, Coutinho
E, Van Landuyt KL, Poitevin A, Lambrechts
P, Van Meerbeek B.
Oper Dent. 2010 Nov-Dec;35(6):624-33. doi:
10.2341/09-379-L.
Effect of surface preparation on bond strength
of resin luting cements to dentin.
Peerzada F, Yiu CK, Hiraishi N, Tay FR, King NM.
Preparation DESIGNS-Burs
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http://www.ncbi.nlm.nih.gov/pubmed?term=De%20Munck%20J%5bAuthor%5d&cauthor=true&cauthor_uid=18199476
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Yiu et al found higher bond strengths were achieved with a self-
etching adhesive when it was applied on dentin surfaces that had
been prepared with carbide burs. There was less penetration of the
milder acids contained in self-etching adhesives through the thicker,
more uneven smear layers produced by diamond burs. The thicker
smear layers also had more of a buffering or neutralizing effect on
the milder acids.
Coarse diamonds produce a thick, uneven smear layer, whereas
carbide burs produce a thin, even smear layer.
The significance in the different smear layers is pertinent when a self-
etching adhesive is to be used.
Yiu CK, Hiraishi N, King NM, Tay FR. Effect of dentinal surface
preparation on bond strength of self-etching adhesives. J Adhes
Dent, 2008;10(3):173-182.
http://www.ncbi.nlm.nih.gov/pubmed/18652265
Baros et al found in their study that carbide burs leave a surface that is more conducive to bonding than diamonds.
Baros JA, Myaki SI, Nor JE, Peters MC. Effect of bur type and conditioning on the surface and interface of dentin. J Oral Rehabil. 2005;32(11):849-856.
http://www.ncbi.nlm.nih.gov/pubmed/16202050
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The last preparation step is to use a tapered finishing bur over the entire prepared tooth surface. This is done for two reasons. First, carbide finishing burs will produce a smoother surface compared to a diamond bur.Ayad MF. Effects of tooth preparation burs and luting cement types on the marginal fit of extracoronalrestorations. J Prosthodont 2009;18(2):145-151. http://www.ncbi.nlm.nih.gov/pubmed/19054303
A smooth, rounded prepared tooth surface reproduces better with all impression materials and die stones.
Also a smooth margin is easier to read on a digitally scanned virtual model.
Burgess JO. Impression material basics. Inside Dentistry. 2005;1(1):30-34.
https://www.dentalaegis.com/id/2005/10/impression-material-basics
Hirata T, Nakamura T, Wakabayashi K, Yatani H. Study of surface
roughness and marginal fit using a newly developed micro-finishing bur and preparation technique. Inter J Micro Dent. 2009;1(1):61-64.
http://www.quintpub.com/journals/micro/pdf_temp/micro_1_1_Hirata_9.pdf
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Margin refinement with electric
handpiece @ 5-10,000 rpms
TIP
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Lithium Disilicate
Zirconium
Crowns
Zirconia
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Round end taper 1122.8/1121.8
End Cutter 5014
Egg 1900
Modified Flap End Taper KR 0816.8
Microcopy
0512C1300F0710C 0116C0818C
Everyday Go To Minimally Invasive Burs
Microcopy
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Electric Handpieces
Electric Handpieces
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NSK
NLZ Electric Handpieces
TISSUE MANAGEMENT…
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Types of Moisture
Saliva
Crevicular Fluid
Bleeding
Fluid/Tissue Management
Superoxol Epinephrine
Ferric Sulfate
ViscoStat 20%
Astringent 15.5%
Aluminum Chloride Viscostat Clear 25%
Expa-syl
Hemostasyl
Aluminum Sulfate
Tissue Goo 25%
Various Cords
Enhancing Moisture Control
Fluid/Tissue Management
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Fluid/Tissue Management
Fluid/Tissue Management
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Lasers (Diodes) Fast
Hemostasis
No crevicular fluid
No cord
Better healing
Enhancing Moisture Control
Fluid/Tissue Management
A soft tissue laser incision at 1000x magnification
Laser cut
Superficial coagulation
Heat dissipation with little/no edema
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TISSUE MANAGEMENT…
Lightweight, portable 5W 810nm soft tissue laser.
Three pre-programmed settings (debride, perio, & cut) & one custom setting.
Rechargeable lithium-ion battery provides three hours of continuous use.
Unique blue-aiming beam, providing greater visibility in intraoral tissues & blood than the traditional red beam.
Two sizes of disposable tips (4mm and 9mm)
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Features
• Number #1 dental laser in the world
• More power – 3 watts 810nm
• New easy to use presets
• New treatment timers for perio treatment
• Wireless foot control
• Optional battery pack
• Perfect for first timers or hygienists
• Affordable
• Disposable tips or fibers
• Certification included
AMD LASER
GEMINI LASER (Ultradent)
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Troughing
AMD LASER
Aesthetic Contouring
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Aesthetic Contouring
Time??
ROI??
Aesthetic Contouring & ExperTemp Provisional
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AMD Picasso Laser Tissue re-contouring, ExperTemp& Impression
Bite Registration
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Verify bite Shimstock
Over Impression Preparation Bite Registration
Dead soft Delar Wax Firm, Hard Bite Reg
Shimstock
Facebow Full Arch Impression Provisional Lab Articulation
PROVISIONALS…• Utilize an accurate preliminary over impression
• Maintain over impression
• Template 30s working time / 30s setting time
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Red Blood Cells 2 – 5um
200-500nm
Human Hair 60 –120um
6,000 – 12,000nm
?
Shimstock & Articulating Paper
What do you use…..
.…and why?
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Parkell Accufilm II is 21µm for dentistry
Great Lakes articulating ribbon 12µm
8µm Almore Shimstock foil
8µm articulating paper??
Shimstock & Articulating Paper
8µm articulating paper
Available in blue
And red too!
TrollDental
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The range of PDL width: 0.15mm ~ 0.38mm
• Average PDL width by age:
o 11 ~ 16 years old: 0.21mm
o 32 ~ 52 years old: 0.18mm
o 51 ~ 67 years old: 0.15mma
• The PDL width decreases with age.
• The PDL width is thinnest around the middle 1/3 of the root.
Tooth with more function has bigger PDL space
PDL & Occlusal Records
Bite Registration & Occlusal IndexingTIP
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Built in errors!Thickness??Rotation?? Rocking??
Function & Failures
Closed Bite Trays (most common)
Lack of rigidity may cause distortion
Spring back after impression potential
No cross arch stabilization
Thin spots or perforations can cause distortion
Impression material shrinks towards bulk
Unable to recreate excursive movements
Potential for errors & adjustments extremely high
Impression Trays
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Quad Tray Extreme (Clinician’s Choice) & Bite
Registration
PEER REVIEWED
The Catapult Group rated
the Quad-Tray Xtreme as
better than, just as good,
or tied with other available closed bite
trays.
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Affinity - InFlex Ultra rigid
Short intraoral cure
No over-displacement of wash material
95% of evaluators said the material was better or the same as current materials for gingival margin quality, impression detail, folds and fins, tears and ease of impression removal. Additionally 90% ranked the Affinity materials better than or equal to comparable materials for voids and bubbles and subgingival detail.
Quadrant & Disposable Articulators
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Bite Registration Importance
• Quick Bite is not brittle and has an ultra-high 90+ durometer cure to eliminate distortion during prosthetic fabrication. Quick Bite cures intraorally in as little as 45 seconds and will not compress during articulation at the dental laboratory
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Disposable Articulators
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Semi Adjustable
not on Hinge Axis
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Semi Adjustable
not on Hinge Axis
TRY-IN / NO ADJUSTMENTS…
A few steps makes
a big difference
Patients notice the
difference.
Do you want to be
like everyone else?
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Key to adjustments Full Arch Impressions
Facebow
Bite Registration
Semi Adjustable Articulator
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CERAMIC ADJUSTMENT
• Jiffy Ceramic Polishers (Ultradent) ASAP INDIRECT +
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CERAMIC ADJUSTMENT
• Feldspathic
• Lithium Disilicate
• Lithium Silicate
• Zirconia
Occlusal Record/Bite Registration
Fast Setting Rigid PVS
Or
Wax
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MODEL ARTICULATION & EQUILIBRATION
Incisal Pins
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Mounted and Equilibrated
Silginat - Kettenbach
Counter FIT- Multipurpose Replication Silicone
(Clinician’s Choice)
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Silginat - Kettenbach
Counter FIT- Multipurpose Replication Silicone
(Clinician’s Choice)
Models
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Selection Process◦ Open Bite Trays
Plastic-full or quadrant
Metal-full or quadrant
Custom Trays
Non-perforated or perforated (metal or plastic)
Rigidity can eliminate tray distortion and rebound
Spring back after impression is possible with plastic
Cross arch stabilization
Ideal occlusal stops for proper model articulation
Able to recreate excursive movements if mounted on a semi or fully adjustable articulator.
Potential for errors & adjustments are low
Impression Trays
Stock tray sizes
Impression Trays
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Difficult for ideal fit
Impression Trays
Custom trays create more ideal placement
Thinner material creates less distortion
USE TRAY ADHESIVES for all open bite
trays, not just custom trays.
Only negative is time
Impression Trays
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Impression Trays
Custom trays create more ideal placement
Thinner material creates less distortion
USE TRAY ADHESIVES for
all open bite trays, not just custom trays.
Only negative is time
Selection Process
Custom Tray
4 upper & lower trays
60 sec. @ 158°F
Fast, efficient
Virtually custom
30% less impression
material used
Impression Trays
HeatWave by Clinician’s Choice
TIP
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Measure on a model or in the mouth to determine size
of tray needed.
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Trays are unique and fit very well with minimal adjustments typically being needed.
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Affinity Heavy Body (Fast) & Light Body HF
Affinity Heavy Body (Regular) & Light Body HF
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Affinity Heavy Body (Fast) & Light Body HF
Impression Trays
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Impression Trays
Impression Trays
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Impression Trays
AFFINTY HEAVY BODY (REGULAR) & LIGHT BODY HF
Make cases easy
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Make cases easy, make your patients happy
Impression Materials
Still account for 85%-90% of
the market.
Types
Vinylpolysiloxanes
Polyethers
Vinylsiloxanether (VSXE)
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(Clinician’s Choice)Affinity Impression Materials
▪ Light Body
High Flow
Regular Flow
▪ Monophase
▪ Heavy Body
▪ InFlex
▪ Quick Bite
Syringe Placement & Mixing tips with
integrated needle
Dry all teeth in arch
Place tip in most difficult area first
Keep tip on margin and immersed in material
Go around entire margin first
Next go to adjacent teeth
Then do coronal aspect of teeth
Double Mix Single Impression is the most accurate
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all-in-one easy mix impression syringe
provides more control intra-orally compared to bulky impression guns and cartridges, and saves you money on costly mixing tips and wasted impression material.
PORTABLE
Simplify Mixing
Faster
Less Expensive
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Impressions & Provisional Tips
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25% aluminum sulfate (will not oxidize & turn black)
25% aluminum chloride
Ultradent ViscoStat Clear
Heat Wave custom tray, Affinity XL Light Body
& Affinity Heavy Body impression material
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Inspire Bead Line Provisionals
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Inspire (Clinician’s Choice)40 second working time
Removal time of 1:30-2:30 minutes & total cure 4:30 minutes. Cut sooner.
4 available shades (B1, A1, A2 and A3.5) provide ideal translucency & fluorescence
High flexural and compressive strength
Elastic Modulus (3136 MPa)
Great polish
Provisionals
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Provisionals
• Utilize an accurate preliminary over impression
• Maintain over impression
• Check contacts and occlusion
Simplified Provisionals**
Siltech Putty Matrix
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Bead Line Veneer Provisional Restorations. Pract Proced Aesthet Dent 2009;21(3):E1-E7.
Duplicate waxup model in stone
Scribe a 0.5-1mm line with a sharp instrument into the
model where the tissue and tooth come together.
Provisionals (Bead Line Technique)
Provisionals (Bead Line Technique)
The scribed line creates the Bead Line in the over impression of the cast.
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From Imaging & Diagnostic Wax-up the entire case was duplicated
-Visalys (Kettenbach)
-TempSmart (GC America)
-Inspire (Clinician’s Choice)
-ExperTemp (Ultradent)
PROVISIONALS
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Simplified Provisionals**
Siltech Putty Matrix
Bead Line Veneer Provisional Restorations. Pract Proced Aesthet Dent 2009;21(3):E1-E7.
Cosmetic Provisionals (Bead Line Technique)
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Cosmetic Provisionals (Bead Line Technique)
Scribe a 0.5mm-1mm groove into tissue & a little on tooth
Cosmetic Provisionals (Bead Line Technique)
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Cosmetic Provisionals (Bead Line Technique)
Cosmetic Provisionals (Bead Line Technique)
No Polish Necessary if you use a good model
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Cosmetic Provisionals (Bead Line Technique)
Cosmetic Provisionals (Bead Line Technique)
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Cosmetic Provisionals (Bead Line Technique)
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Cling 2 (Clinician’s Choice) for all my full crowns & bridges,
retentive inlays & onlays.
My Favorite Temporary Cements
ClearTemp LC (Ultradent)
For either veneers or thin
anterior cosmetic restorations
is a zinc-oxide non-eugenol, automix temporary cement with a unique polycarboxylate resin
The addition of polycarboxylate optimizes adhesion, soothes the tooth, and provides an
excellent seal, while allowing the material to be easily removed from the tooth preparations
when desired.
Cling 2 (Clinician’s Choice)
30 second working time, 60-90 second set time
Good adhesion, easy removal
Low film thickness
Excellent marginal seal
Biocompatible – protects the gingival tissue
Resists forces of mastication
2 year shelf life
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Another Case Of The Week
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Provisionals (Temp Tray, Template) Clinician’s
Choice• Utilize an accurate preliminary over impression
• Maintain over impression
• Template 30s working time / 30s setting time
Another Case Of The Week
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▪ Heat Wave Thermoplastic
Tray
▪ #00 Record
▪ Tissue Goo if necessary
▪ Bite Registration
▪ Photograph
▪ Inspire Temporary
▪ Cling 2 Temp Cement
Another Case Of The Week
Utilize an accurate preliminary over impression
Maintain over impression
Check contacts and occlusion
Place temp cement only on margins
Do not fill temp with cement
Or vent holes
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Photography to check color match
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REVIEW
• Full arch impression Heat Wave Tray
• Record or Diode laser
• Light & Heavy Body Impression Material (Affinity)
• Bead Line Provisional Technique (Inspire) uses no temp cement or
adhesives, mechanical retention, shrink wrapped (using Template)
Indirect Restorations
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Crown Classification
• Lithium disilicate/silicate *
• IPS e.max Press/CAD; Obsidian
• High esthetics and strong
• 360-400 MPa
• Zirconia (high strength non-etchable) *
• Monolithic: BruxZir; LAVA Plus; KDZ Bruxer; OccluZir; ZirLux FC
• Fastest growing; improved esthetics~1000 MPa
• Zirconia supported: IPS e.max ZirPress; ZirCAD, LAVA DVS,
• High esthetics; may be subject to chipping, fractures; slow cooling
• Zirconia Multi-layered *
• CAP Multi-FZ
• Katana HT, ST, UT
• Translucency, esthetic and strong
• 557-699-1125 MPa
Indirect Restorations
All-Ceramic Crowns565-1200+MPa
Multi-Layered
Zirconia
Indirect Restorations
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Zirconia Multi-layered
Zirconia Multi-layered
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Zirconia Multi-layered
All-Ceramic Crowns
Zirconia Multi-layered
(557-1125mpa)
Anterior Crowns
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0
10
20
30
40
50
KATANA
Zirconia HT
KATANA
Zirconia ST
KATANA
Zirconia UT
e.max Press LT Prettau Anterior
(%)
High translucent for anterior restoration
The same level translucency as
glass ceramic (e.max Press LT)
Wave length of
light: 700nm
Thickness of
sample: 0.5mm
LT (A1)ST (ST10) UT (UT10)HT (HT10) (T0)
Prettau Anterior
Tra
nslu
ce
ncy
Lithium
DisilicateMulti-Layer Zirconia
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Thickness of
sample: 1.2mm
Tra
nslu
ce
ncy
(⊿L(W-B))
0
5
10
15
20
KATANA
Zirconia HT
KATANA
Zirconia ST
KATANA
Zirconia UT
e.max Press LT Prettau Anterior
Multi-Layer Zirconia
LT (A1) (T0)
Prettau Anterior
ST (ST10) UT (UT10)HT (HT10)
High translucent for anterior restoration
Lithium
Disilicate
The same level translucency as
glass ceramic (e.max Press LT)
Mechanical Properties
30% Increase Compared to Lithium Disilicate
ISO 6872：2008
(Three-point bending test)
Sample size: 3 x 4 x 40 mm
Prettau Anterior 670mpa
Fra
ctu
ral s
tre
ng
th
.
1125
699
557
427
0
200
400
600
800
1000
1200
KATANA
Zirconia HT
KATANA
Zirconia ST
KATANA
Zirconia UT
e.max Press LT
Multi-Layer Zirconia
LT (A1)Lithium
Disilicate
ST (ST10) UT (UT10)HT (HT10)
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Zirconia Aesthetics
Zirconia Aesthetics
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Zirconia Aesthetics
Traditional Resin CementationConventional methods applied to the bonding of
silica-based ceramics are not successful. You cannot acid etch and silanate the intaglio surface of metal
oxide ceramics as you can with lithium disilicate
(e.max) or other glass ceramic restorations.
HF acid does not sufficiently alter the surfaces ofmetal oxide ceramics, and conventional silane
coupling agents cannot provide chemical bonds to
these materials because of the lack of silica.
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Zirconia CasesShould be delivered from the lab having been
sandblasted with aluminum-oxide particles. Research shows small particles (30 µm) @ low pressure (35 psi) to
enhance resin bonds while minimizing surface damage.*
Prior to Try-in
The internal surfaces should be coated
with a ceramic/metal primer that
contains adhesive monomers that
chemically bond to metal oxides.*
MDP has been shown to offer the most
consistent bonds to zirconia
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MDP Monomer
Developed by Kuraray 1983
• Acidic Monomer Activates Silanes & Chemically Bonds to Metal Oxide Ceramics (Zirconia & Alumina).
• (Key Ingredient to make a Silane Universal)
• Hydrophilic & Hydrophobic
• Very Durable Dentin Bond
(Creates An Insoluble, calcium Salt with Dentin)
• Is The Most Copied Monomer In Dentistry
• The Most Researched Monomer In Dentistry
• 20 + Years Of Research On Metal Oxide Ceramics (Zirconia & Alumina)
• Strongest & Most Durable Bond to Metal Oxide (Zirconia & Alumina) Ceramics
Primers
Universal Adhesives (w/MDP)
Silane Primer + MDP
Organo-Phosphate Monomer (MDP)
Silane Primers
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Zirconia Ceramic Conditioning
Zirconia Cleaning Try-in contaminates
the surface more than if a ceramic primer is not present.
Salvia contains phosphates so they compete for the same receptor sites as the ceramic primers
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• Primer was applied
on Zr surface
• Ultrasonicated in ethanol to remove unreacted resin components 0.0
20.0
40.0
60.0
80.0
NP AZ ZP MP CC SBU ABU
Pure
ZrPrimer
Silane
ZrPrime
r
Silane
ZrPrimer
Adhesive
ZrPrimer
Adhesive
LC required
Contact Angle as
Zr Primer
0
5
10
15
20
MDPKuraray
MDPPCM
MDPDMI
24hr
TC100000
Bond durability of phosphate monomers with different purity Okayama Univ. (Yoshihara K, et al.)
The 33rd Meeting of the Japanese Society for Adhesive Dentistry, 2014, P-7
Primer：15% MDP solutionBond： Same BondComposite： Same
Micro tensile bond strength to Dentin
(MPa
)
“MDP”s perform differently
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MDP-containing material bonds to Zirconia
CLEARFIL™ CERAMIC PRIMER
MDP
γ-MPS
Ethanol
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REVIEW: Ceramic Try-in
Make sure it is sand blasted properly from lab
Use a Ceramic Primer prior to try-in (unless using Calcium Aluminate Cement)
Ultrasonic with ethanol after try-in
No additional MDP Ceramic Primer needs to be used.
Or
Sandblast after try-in and use a MDP Ceramic Primer then follow cementation protocols
Zirconia Cementation Review➢ Silanate with Clearfil Ceramic Primer prior to tryin**
➢ Clean with ethanol or steam clean then reapply ClearfilCeramic Primer
➢ Difficult Isolation use:
➢ Resin modified glass ionomer (Use Ceramic Primer)
➢ **Ceramir (Do not silanate or use a ceramic primer)
➢ Good isolation with moderate to good resistance & retention
➢ Ceramic Primer
➢ SE Dual Cured Resin cement such as Panavia SA Plus Or GC LinkAce
➢ Good isolation with poor to moderate resistance & retention➢ Ceramic Primer
➢ Resin adhesive and bonding agent
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Sand Blaster
Ceramic Primer (MDP)
Resin
Universal
Zirconia
Etched/Self Etch
1. Prepare Restoration Surface
Sand Blaster 30um @35psi2. Ceramic Primer (MDP)
3. Etch Enamel 15-30 secs. Etch Dentin 10-15 secs
4. Apply Adhesive. Apply into preparation X secs. Thin with air X secs. Light Cure.
5. Seat Restoration. Load cement into restoration. Seat & remove Most excess.(Air inhibiting liquid) Light cure.
Bonded Adhesion
Bonded Adhesion
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Bonded Adhesion
Bonded Adhesion
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Enamel & Variable Dentin Bonding
NEXT Problem:Varying tooth substrates
Maintain good retention and resistance preparation design
Cementation
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Adhesion
Adhesion
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Class I or II
:Tooth Preparation
3x Tubule Density Equals Higher Fluid &
Increased Difficulty for Bonding 30% Decrease in
Bond Strengths with most bonding systems.**
What substrate are we treating?
Restoration Placement? Bonded
Margin placement Moisture Control Technique Sensitive Materials
Self Adhesives
Bonding agent (TE or SE) & luting resin
Cemented
Margin placement
Moisture Tolerant
Retention Required
Materials
RMGI
Ceramir
Cement Selection
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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3148178/
(RFA-DE-10-004) “Tooth-colored resin restorations have an
average replacement time of 5.7 years due to secondary caries precipitated by bond failure.”
Factors that compromise bond durability in restorative dentistry
We challenged that current dentin adhesive designs that incorporate increasing concentrations of hydrophilic monomers are going in the wrong
direction
Water sorptionPolymer swelling
Decline in mechanical propertiesLeaching of hydrolyzed resin components
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BOND LOCATION& DEGRADATION
• Pashley DH, Tay FR, Imazato S. How to increase the durability of resin-dentin bonds. Compend Contin Educ Dent. 2011 Sep;32(7):60-4, 66.
Resin-dentin bonds are not as durable as was previously thought. Microtensile bond strengths often fall 30% to 40% in 6 to 12 months.
3x Tubule Density Equals Higher Fluid &
Increased Difficulty for Bonding
30% Decrease in Bond Strengths with most
bonding systems.
Factors that compromise bond durability in restorative dentistry
MMP-8MMP-2MMP-9
Demineralizing dentin is like openingthe Pandora’s box, releasing
endogenous enzymes (Matrix Metalloproteinases - MMPs)
that were trapped withinthe mineralized dentin matrix.
In the presence of water (such as thatderived from water sorption or from
adhesives, MMPs (2,8 & 9) can breakdowncollagen fibrils that are not protected
by intrafibrillar minerals
Sukala et al. (2007)Mazzoni et al. (2007)
Factors that compromise bond durability in restorative dentistry
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Intact hybrid layers created by a simplified etch-and-rinse adhesive in caries-affected primary dentin partially
disappeared after 6 months of intraoral function
Instability of hybrid layersproblem may be more severe than we realize
Factors that compromise bond durability in restorative dentistry
Cementation Material Options
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Traditional Cementation Options
Glass Ionomers Resin Modified Glass Ionomers
Acidic pH
Moisture Tolerant
Fluoride Release
Degrades over time
Low bond strength
Biocompatibility-Fair
Bioactivity-None
Sealing Quality-Ok
Acidic pH
Insoluble
Moisture Tolerant
Fluoride Release
Stronger Than Traditional GIs
Degrades over time
Improved bond strength
Biocompatibility Ok
Bioactivity-None
Sealing Quality-Ok
Ceramic Primer on Restorations
Cement Selection
TRADITIONAL GLASS IONOMER
CEMENTATION OPTIONS
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Resin Modified Glass Ionomer Cements Use Ceramic Primer prior to try-in
Clean with ethanol after try-in
Keep tooth slightly moist and place RMGI cement
as it will chemically cure to the tooth and the Ceramic Primer
Still want to always have good prep design
Resin Modified Glass Ionomer
Cement and a Ceramic Primer Lab sandblasts @ 30psi w/ 50 micron aluminum-oxide
particles
G-Multi Primer (MDP) prior to tryin
Ultrasonic clean with ethanol
Place FujiCEM2 RMGI cement in restoration
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Cementation
Cementation
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Alkaline pH 8.5
Moisture Tolerant
Self Sealing
Apatite Formation
Insoluble/No Degredation
Stronger with time
Semi / Translucent
Biocompatibility-Excellent
Bioactivity-Apatite formation
No silane, conditioning, bonding
Calcium Aluminate/Glass Ionomer Hybrid Cement**
TIP
Bioactivity
A reactive bioactive system that contributes to hydroxyapatite mineralization of hard tissue through ion release and alkaline
pH.**
Calcium Aluminate/Glass Ionomer Hybrid Cement**
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Cementation Technique
Mix for 8-10 seconds
.17ml vs single cap .10ml
3-4 restorations
Calcium Aluminate/Glass Ionomer Hybrid Cement**
Lithium Disillicate (eMax)• Cleaning
w/phosphate scavengers is not necessary
• Silane is
contraindicated
• Tooth etching or conditioning is not necessary
• Bonding agent is not needed
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CEMENTATION TECHNIQUE
Zirconia Restorations- Cleaning w/ phosphate
scavengers is not necessary
- Silane is contraindicated
- Tooth etching or conditioning
is not necessary- No bonding agent necessary
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Crown RetentionResults Zirconia crowns (Kg/F)
Material Result (Zirconia crowns) Kg/F
Ceramir Crown & Bridge 32.1 ± 6.3
RelyX Unicem (3M) 27.8 ± 11.3
Dyract Cem (Dentsply) 12.2 ± 3.1
Rely X Luting (3M) 10.9 ± 6.5
0
5
10
15
20
25
30
35
Ceramir Crown &
Bridge
RelyX Unicem (3M) Dyract Cem
(Dentsply)
Rely X Luting (3M)
Cement Selection
Three year recall data yielded no loss of retention, no secondary caries, no marginal discoloration, and no
subjective sensitivity. All restorations rated excellent for marginal integrity.
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Cement SelectionJournal of Esthetic & Restorative Dentistry March 2015
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Simplify Cementation
-Silane is contraindicated
-Restoration does not have to be cleaned after tryin
-Tooth etching or
conditioning is not necessary
-Bonding agent is not needed
Technique Research/Literature**
Moisture Tolerant
No Sensitivity
Alkaline pH
Apatite Forming
Insoluble
Stronger With Time
Self Sealing
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ResinCement Options
Self Adhesive Resin Acidic/Neutral pH
Not moisture tolerant
Low-moderate initial bond strengths
Decreased bond strength over time
Water sorption
Biocompatibility-Ok
Bioactivity-None
Sealing Quality-Ok
Bonding Agent w/ Resin Acidic/Neutral pH
Not moisture tolerant
Best initial bond strengths but can decreases w/time
Decreased bond strength over time
Water sorption
Biocompatibility-Ok
Bioactivity-None
Sealing Quality-Good but technique sensitive
SE Resin Cements
Self-Adhesive Resin Cements Without a Primer or Bonding Agent have less:
• Wettability
• Which Results in Less Contact to the Tooth
• Which May Result in a Less Durable Bond
• Acid Neutralization
• Prolonged Gel State
• Convenience
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All Ceramic Crown Microleakage
Bonded Resin Cement SE Auto Resins
After simulated aging through cyclic loading (1.2 million) and dye penetration test to
detect Microleakage. LSU Dental School. IADR 2006, Abstract #2090.
LITHIUM DISILICATE & SILICATE, LEUCITE, ZIRCONIA AND
FELDSPATHIC RESTORATIONS
USE AN ADHESIVE CEMENTATION
SYSTEM THAT IS EASY-TO-USE,
EFFICIENT AND HIGHLY
EFFECTIVE ON SELF CURING
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REVIEW• Electric hand pieces & disposable Microcopy burs
• Soft tissue management with hemostatic & cord or a diode laser
• Customizable thermoplastic tray or Quad Tray Extreme
• Beadline Provisional Technique & over impression with Template
• Facebow & Bite Registration
• Cling II temp cement just on margins
• Bioactive cements Vs Resin Cements
•
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