Dental Cements

Introduction
Definitions of terms used
Classification
-based on use
-based on chemical ingredients
ANDA /ADA specifications
-No 96 for dental water based cements
-No 30 for dental zinc oxide-eugenol cements and
zinc oxide non eugenol cements
 Silicate cement
 Zinc phosphate
 Zinc polycaboxylate
 Zinc oxide eugenol
 Glass ionomer cement
 Compomer cement
 Resin ionomer cement
 Summary
 References
 Definitions of terms used

 Cement-substances that hardens to act a base, liner,

filling material or adhesive to bind devices and prostheses
to tooth structure or each.
 Base- layer of insulating sometimes medicated cement,
placed in the deep portion of the preparation to protect
pulpal tissues from thermal and chemical injury.
 Cavity liner-Thin layer of cement such as a calcium
hydroxide suspension in aqueous or resin carrier (after
evaporation) , used for protection of the pulp
 Varnish- a solution of natural gum, synthetic resin, or
dissolved in a volatile solvent such as acetone , ether or
chloroform .
 Def contd
 Restoration- filling material or prosthesis used to restore
or replace a tooth, a portion of a tooth , multiple teeth or
other oral tissues.
 Working time –time elapsed between from start of
mixing time to point at which consistency of a material is
no longer suitable for its intended use
 Setting time-Time elapsed from start of mixing to point
at which consistency of a material reaches the desired
consistency
 Introduction
A variety of cements have been used in dentistry
throughout the years. they have been mainly used for
two main purposes –
1. As restorative materials, either alone or with other
materials
2. To retain restorations or appliances in a fixed position
in the mouth (for luting)
In addtion ,certain cements are used for specialised
purposes in restorative, endodontic, orthodontic and
periodontic fields.
 Classifications
A. Based on use
B. Based on chemical ingredients
 Classification based on use
1) Cementation (Luting)
a. Cementation of cast alloy crowns and bridges.
b. Cementation of all ceramic or composite inlays
c. Cementation of resin bonded bridges.
d. Temporary cementation of cast crowns and
bridges & temporary restorations
2) High strength bases
3) Low strength bases
4) Liners
5) Cementation of orthodontic bands
6) Direct bonding of orthodontic brackets
7) Root canal sealers
 Classification based on chemical
ingredients
1) Zinc phosphate cement
2) Silicate cement
3) Zinc oxide eugenol cement
4) Zinc oxide non eugenol cement
5) Zinc polycarboxylate
6) Glass ionomer cement
7) Resin cement
8) Compomer cement
 ANSI /ADA specifications
-No 96 for dental water based cements
Cement Film Net setting Compressive
thickness, time(mins) strength
maximum (MPa)
(micro
meter)
Glass ionomers(Luting) 25 2.5-8.0 70

Zinc phosphate(Luting) 25 2.5-8.0 70

Zinc Polycarboxylate (Luting) 25 2.5-8.0 70

Glass ionomer (Base/Liner) - 2.5-6.0 70

Zinc phosphate(Base/Liner) - 2.5-6.0 70

Zinc - 2.5-6.0 70
Polycarboxylate(Base/Liner
)
Glass ionomers(restorative) - 2.5-6.0 130
 ANSI /ADA specifications
-No 96 for dental water based cements
Cement Acid Erosion, Acid-soluble Acid-soluble
Maximum Arsenic content Lead content
(mm/hour) (mg/Kg) (mg/Kg)
Glass ionomers(Luting) 0.05 2 100

Zinc phosphate(Luting) 0.1 2 100

Zinc Polycarboxylate (Luting) 2.0 2 100

Glass ionomer (Base/Liner) 0.05 2 100

Zinc phosphate(Base/Liner) 0.1 2 100

Zinc 2.0 2 100

Polycarboxylate(Base/Liner)

Glass ionomers(restorative) 0.05 2 100

 ANSI /ADA specifications
-No 30 for dental zinc oxide eugenol
and non eugenol cements
Cement
ANSI /ADA specifications
Setting
time at 37
Compressive
strength (24
Maximu
m
Film
thickness,
Acid-soluble
Arsenic

-No 30 for dental zinc oxide eugenol

degree C
(mins)
hr) (MPa) Disintegr
ation
maximu
m (micro
content
(mg/Kg)

and non eugenol cements 24 hr(%) meter)

Type 1.temporary cement 4-10 35 Maximum 2.5 40 2

Class1 - Powder-liquid 4-10 35 Maximum 2.5 40 2
Class 2a - Paste-Paste 4-10 35 Maximum 2.5 40 2
(eugenol) - - - 40 2
Class 2b - Paste-Paste
(non eugenol)
Class 3 -Paste-Paste

Type II Permanent 4-10 35 Minimum 1.5 25 2

cement
Class1 - Powder-liquid
Type III filling materials 2-10 25 Minimum 1.5 - 2
and Bases 2-10 25 Minimum 1.5 - 2
Class1 - Powder-liquid
Class 2 - Paste-Paste

Type IV Cavity Liners 4-10 5 Minimum 1.5 - 2

Class1 - Powder-liquid 4-10 5 Minimum 1.5 - 2
 SILICATE CEMENT

Silicate cement - FLETCHER in 1873.

Mixing a powder made of Alumino-Fluoro-Silicate glass with a
very strong solution of phosphoric acid.
Until the advent of resin composites, silicates were the only tooth
colored filling material, and the only alternative to silver amalgam
as a simple permanent filling material.
Its use was limited to front teeth, or areas of decay on non stress
bearing surfaces of back teeth.
 COMPOSITION

POWDER

Silica
Alumina
Fluoride compounds, such as sodium fluoride, calcium
fluoride to lower fusion temperature.
Calcium salts such as, Calcium oxide .

LIQUID

•Aqueous solution of PHOSPHORIC ACID with buffers

 MANUFACTURE
The ingredients are fused at temperature of 1400 °c to form
glass.

SETTING REACTION

When powder and liquid are mixed ,the surface of powder

particles are attacked by the acid, releasing calcium ,aluminium
and fluoride ions. the metal ions ppt. as phosphate that forms
the cement matrix with inclusion of fluoride salts.
 PHYSICAL PROPERTIES
•Compressive strength: 180Mpa
•Diametral strength: 3.5Mpa
•Hardness : 170 KHN
•Solubility (ADA no.9) : 0.7

BIOLOGICAL PROPERTIES:

The ph of silicate cement is less than 3 at the time of insertion

into the cavity,and it remains below 7 even after a month.
It is classified as a severe irritant to the pulp and serves as
the reference material to judge the potential of other
materials to elicit a relatively severe reaction.
 Zander et al concluded in their studies that that
silicate cement is highly irritating to the pulp and
zinc oxide should always be used as a base under
silicate cement.
 However more recent research shows it to be
not true.
 Skogedal and Mjor placed silicate in unlined
cavities. Irritation dentin was induced under the
silicate cement in all cases.16 out of 17 pulps
showed slight or no reaction whereas only one
pulp was moderately inflammed.
 Tobias et al conclude that majority of pulpal inflammation
under silicate cement is due to microlekage at the
material/cavity wall interface and not due to the cement
itself
 Cox and Bergenholtz inserted silicate cement directly in
contact with the pulp and prevented microlekage with a
zinc oxide eugenol overlay. At 21 days they reported new
hard tissue formation directly adjacent to the cement pulp
interface,a phenomenon earlier attributed exclusively to
calcium hydroxide.
 However it is doubtful that same results (complete tissue
healing and hard tissue repair) can be obtained in the
stressed pulps of carious teeth. This needs further
evaluation
ADVANTAGE

1. Its color i.e. esthetics.

2. Fluoride from the glass tended to prevent further
decay around the margins of the filling.

DISADVANTAGE
1. Lack of translucency
2. The brittleness of the matrix is another esthetic difficulty
since it causes surface crazing and marginal chipping as
the restoration ages. These defects tend to collect stains
which further degrades the appearance of these fillings.
3.Dissolution in oral fluids.
4.Contraindicated in mouth breathers.
5. Pulp reaction(?)
 Tunnel preparations
 First described by Jinks in 1963.
 The procedure included placing silver alloy
mixed with sodium silicoflouride in distal
aspect of primary second molars with the
objective of inoculating the 1st permanent
molar with flouride as they continue to
erupt in the oral cavity.
 Hunt and Knight later modified it for
restoring small interproximal carious
lesions.
 Advantages of tunnel prep
1) More conservative
2) Reduced potential for microleakage
3) If required the preparation can be
modified into coventional class II
preparation.
 Disadvantages of tunnel prep
1) Highly technique sensitive
2) Can encroach on pulp
3) Reduced visiblity
4) Uncertain caries removal
5) High rate of residual caries
 Zinc phosphate cement
Zinc phosphate cement by DR.PIERZE in 1879.It is one of the
oldest dental materials.
It has been used for at least two hundred years.

APPLICATIONS
•Luting of restorations ,orthodontic bands and brackets
•High strength bases
•Temporary restorations

CLASSIFICATION
ADA specification no.8
•Type 1 fine grained for luting
Film thickness 25mm
•Type 2 medium grain for filling
Film thickness should not be more than 40mm
 MODE OF SUPPLY

•Powder and liquid system

•Capsule of pre-proportioned powder and liquid

COMMERCIAL NAMES
Shofu Harvard
 COMPOSITION

POWDER

• Zinc oxide - 90% principal constituent

• Magnesium oxide - 10%aids in sintering
• Other oxides
• [Bismuth trioxide ,calcium oxide, barium oxide.etc] –imparts
smoothness to mix
• Silica- 1.4% filler aids in sintering

Liquid

• Phosphoric acid ,33+5% -reacts with zinc oxide

• Water ,36% -controls the ionization of acid
• Aluminium phosphate/zinc phosphate,16%-buffer to reduce rate
of reaction
 MANUFACTURE

The ingredients of the powder are sintered at temperature between 1000°C

to 1400 °C into a cake that is subsequently grounded into fine powder.

SETTING REACTION
When the powder is mixed with liquid ,the phosphoric ions attacks the
surface of the particles and releases zinc ions into the liquid. Aluminium,
which already forms a complex with the phosphoric acid reacts with zinc
and yields a ZINC-ALUMINOPHOSPHATE GEL on the surface
of the remaining portion of the particles .Thus the set cement is a cored
structure consisting of un-reacted zinc oxide particles embedded in a
cohesive amorphous matrix of zinc aluminophosphate.

Powder + liquid = zinc aluminophosphate

[zinc oxide] [phosphoric acid]
SET CEMENT;

the set cement is a cored structure consisting primaraly of

unreacted zinc oxide particles embedded in a cohesive amorphous
matrix of zinc aluminophosphate

WORKING TIME
Measured as the time from the start of the mixing to the
maximum time at which the viscosity of the mix is still low
enough to flow readily under pressure to form a thin film.

SETTING TIME
The period during which the matrix formation has reached
a point at which an external physical disturbance will not
cause permanent dimensional changes
2.6 To 8min [ ADA NO.96]
 EXTENDING THE SETTING TIME

1.Reducing the powder liquid ratio

Affect the physical properties
Low initial Ph of the cement

2.Mixing cements in increments and introducing small quantity of powder

into the liquid
Permits more powder incorporation [decreases acidity ]

3.Prolong spatulation of last increments

The matrix is destroyed as it is forming .Fragmentation of the matrix
means extra time is needed to rebuild the bulk of matrix

4.Cooling the slab

Retards the chemical reaction between the liquid and the powder –
thereby retards formation of matrix
Incorporates optimum amount of powder
PHYSICAL PRORERTIES

•Compressive strength - 140 MPA

•Diametral tensile strength- 5.5 MPA
•Modulus of elasticity- 13.7 GPA

FACTORS EFFECTING STRENGTH-

1.Powder liquid ratio-

More the powder added into the liquid ,greater is the
strength.
2.Water content-
Loss gain of water reduces the strength
 SOLUBILITY

ADA -0.06%
Zinc phosphate solubility is greater in dilute organic acid, such as lactic
acid, acetic acid and citric acid

RETENTION
•No chemical reaction
•Bonding occurs by mechanical interlocking.

BIOLOGICAL PROPERTIES
Acidity of the cement is higher initially ,2min after the start of the
mixing , the pH of the cement is 2 . The pH increases rapidly to 5.5 at
24hrs,from this data any damage to the pulp from acid occurs during
first few hrs of placement of cement.
 MANIPULATION

Powder liquid ratio- 1.4g powder to 0.5ml of liquid

1. Cool glass slab is used in order to delay the setting and allow
more powder to be incorporated before the matrix formation
occurs.
2. The liquid should be dispensed just before mixing.
3. Powder added in small increments
4. A large area is used during mixing in order to dissipate the
exothermic heat during mixing
5. Maximum amount of powder should be incorporated into the
liquid to ensure minimum solubility and maximum strength of the
cement
PROCEDURE

Place required amount

of cement powder, and
liquid on the glass slab

Using a #24 cement

spatula, divide the powder
into increments
Incorporate one increment of powder into the liquid
mixing the approximately 10 seconds. Spatulate the mix
over as wide an area as possible on the glass slab (60% or
more). Mixing over a wide area of the cooled glass slab
maximally dissipates the heat generated by the exothermic
chemical reaction. This helps maintain cement fluidity. If
the cement becomes too viscous during the mixture, it will
be impossible to fully seat the casting. Keep the mix away
from the remaining increments of powder. Make certain
that the liquid comes in contact with all the powder
particles to assure a uniform mix.
Continue to add increments to the mix. Spatulate
thoroughly over a wide area using approximately 10
seconds for each addition .At the end of the mixing, as
much powder as possible should have been avoided without
producing a mix that is too viscous. An increased powder
to liquid ratio improves strength and reduces solubility but
it also increases viscosity which may prevent complete
seating of the casting.
After adding the 1/4 increment of powder, check to
determine if the proper viscosity of cement has been
achieved. Push the mixed cement into a central pool,
place the flat portion of the #24 cement spatula into the
mixture and slowly raise (1-2 seconds) it directly above
the pooled cement.
When properly mixed, at a distance greater than one
inch the string formed between the spatula and the pool
will break. If the cement is too fluid, the string will fall
away immediately or not form at all. When this
happens more powder should be incorporated into the
mix. If the cement is too viscous it will form a wide
band of cement and which can be drawn more than one
inch above the glass slab. A cement that is too thick
must be discarded and the mixing procedure begun
again. Adding more liquid interferes with the setting
reaction and weakens the cement. It should require
approximately 2 minutes to mix the cement to its
proper consistency.
 Clincial applications
1) Luting agent for cementation of
permanent metal restoration.
2) Luting of orthodontic bands
3) High strength base
4) Provisional restoration
 Zinc silicophosphate cement
 Combination of zinc phosphate and
silicate cements in attempt to combine
good properties of the two cements
 Composition
 Powder –various proportions of the two
cement powders were attempted. most
commonly used contained 90% silicate
cement and 10% zinc phosphate cement
powder,
 Liquid- Phosphoric acid containing 45%
water+ 2 t0 5% aluminum and zinc salts
with remaining consisting of phosphoric
acid
 Some amount of mercury and silver were
also present in the powder.
 So this cements were labelled as having
germicidal properties.
 But the claims were unsubstantiated
 Type I-luting of fixed restorations and
orthodontic brackets
 Type II –Temporary posterior filling
material
 Type III – Dual purpose material
 Setting reaction
 It is same as that of silicate cement except
for additional formation of zinc phosphate
salts
 Manipulation
 The mixing of the cement is similar to that
of zinc phosphate cement.
 The same precautions should be taken.
 The freshly mixed cement should be
glossy with putty like consistency.
 Biological properties
 It has a prolonged low pH.the cement
remains acidic for a very longer period
than zinc phosphate cement.
 It behaves as more severe irritant than
zinc phosphate.
 Hence pulp protection is necessary when
placed in vital teeth
 Flouride ions are leached from set cement
when it comes in contact with oral fluids
leading to increased enamel fluoride
adjacent to the cement
 Advantages
 Better compressive strength than zinc
phosphate cement
 Better toughness and abrasion resistance
compared to zinc phosphate
 Has anti cariogenic properties
 Disadvantages
 Lower initial pH than zinc phosphate
 Shorter working time compared to zinc
phosphate
 Coarser grain size leading to thicker film
consistency
 Manipulation more critical than zinc
phosphate cement
 Copper cement
 Closely related to zinc phosphate
cement
 Rarely used nowadays
 Composition –
Powder- mixture of zinc oxide and black
copper oxide(cupric oxide)
Liquid -Phosphoric acid
Setting reaction- It is very similar to that of
zinc phosphate with formation of copper
phosphate salts in addition
It is manipulated in same way as zinc
phosphate cement
 Black appearance due to presence of
copper oxide.
 Have bactericidal properties due to
presence of copper oxide
 Poor biological properties as at pH of 5.3 it
is an irritant to the pulp
 Applications
1) Intermediate restoration in deciduous
teeth
2) Cementation of orthodontic bands
 ZINC POLYCARBOXYLATE CEMENT

Polycarboxylate cement by SMITH in 1968 .It is a newer innovation than

zinc phosphate cement. In this case, zinc oxide powder is mixed with
polyacrylic acid
FIRST CEMENT THAT DEVELOPED ADHESIVE BOND TO TOOTH
STRUCTURE
MODE OF SUPPLY

Powder and liquid system

Capsule of preproportioned powder and liquid
Powder mixed with water [water settable cements]
COMMERCIAL NAMES; E.g.

3M Espe Dentsply
COMPOSITION

Powder

•Zincoxide - 90%principal constituent

•Magnesium oxide - 10%aids in sintering-
•Bismuth
•Aluminum/
Stannous fluoride- modifies the setting time and enhances the
manipulation properties [Increases strength]
- Small amount of fluoride is released

Liquid

Aqueous solution of polyacrylic acid or a copolymer of acrylic acid

with other carboxylic acid [itaconic acid]
Acid concentration 32% to 42% by weight
Molecular weight of polyacid 30,000 to 50,000 range
 WATER SETTABLE CEMENTS

In this the polyacid is freeze dried and that powder is then

mixed with the cement powder. water is used as a liquid.
when powder is mixed with the water, the polyacrylic acid
goes into the solution and the reaction proceeds as
described for conventional cement.
Eg.TYLOK®-PLUS™ (Caulk)
ANHYDROUS POLYCARBOXYLATE CEMENT.
Mixes with tap water.

MANUFACTURE
The powder mixture is sintered at high temperature in
order to reduce the reactivity and then ground into
fine particles.
 SETTING REACTION

When powder and liquid are mixed ,the surface of powder

particles are attacked by the acid, releasing zinc,
magnesium and tin ions. these ions bind to polymer chain
via cross linked salts.

Powder + liquid = Zinc polyacrylate

 SET CEMENT

The hardened cement consist of an amorphous gel matrix of

zincpolyacrylate in which unreacted powder particles are dispersed.

SETTING TIME

•7to 8 min
•The setting time can be increased by cooling the glass slab. It
also depends on the method of manufacturer.
 PROPERTIES

Mechanical properties

Compressive strength ; Inferior to zinc oxide cement

55Mpa-800psi

Diametral tensile strength; 6.2 MPa slightly higher

than zinc phosphate

The strength of the cement depends on:

Powder /liquid ratio -increase in powder liquid ratio

increase in strength.
Molecular weight also affects the strength
A mix from low viscosity liquid is weaker in strength
 SOLUBILITY

ADA -0.06%

•It
tends to absorb water and is slightly more soluble than
Zinc phosphate.

•Solubilityis greater in dilute organic acid ,such as lactic

acid, acetic acid and citric acid

•Alsoa reduction in P/L ratio results in a significantly higher

solubility and disintegration rates in oral cavity.
 BIOCOMPATIBILITY

Despite the initial acidic nature of the cement, pulp response is

classified as mild. The pH of the liquid is 1 -1.7 and that of
freshly mixed cement is 3.0 – 4.0 .After 24hrs ,the pH of the
cement is 5.0-6.0.They less irritant to the pulp than zinc oxide
cement.

This is because ;

1.The liquid is rapidly neutralized by the powder. The pH of the

polycarboxylate rises more rapidly than that of zinc phosphate.

2.Penetration of polyacrylic acid is less to dentinal tubules

because of high molecular weight and large size.
 ADHESION

Cement bonds chemically with the tooth structure. This is due

to ability of carboxylic group in the polymer molecule to chelate
with the calcium of tooth structure.
Bond strength is 3.4 to 13.1 MPa with enamel and 2.07 MPa with
the dentin.

OPTICAL PROPERTIES ;
They are opaque because large amount of unreacted zinc oxide.

THERMAL PROPERTIES ;
good thermal insulators
 MANIPULATION

Powder-liquid ratio:1.5 parts of powder to 1 part of liquid

1.The tooth should be meticulously cleaned to provide intimate

contact and interaction between cement and the tooth.
2.Mixing is done on a glass slab or treated paper pad.
3.The powder may be cooled ,but the liquid should not be cooled
since the viscosity of the liquid increases.
4.The Cool glass slab is used in order to delay the setting and
allow more powder to be incorporated before the matrix
formation occurs. The liquid should be dispensed just before
mixing
5.Powder is incorporated into the liquid in large quantities(90%) with a
stiff spatula and remaining powder is added to adjust the
consistency. the mixing should be completed in 30 to 40 sec in order
to provide sufficient working time. the mix appears quite thick but it
will flow readily into a thin film when placed under pressure.

6.The cement should be used when the surface is still glossy. Loss of
luster and dull ,stringy ,rubbery consistency indicates that the setting
reaction has progressed to an extent that proper wetting of the tooth
surface by the mix is no longer possible.

7.When placed in the cavity ,do not remove excess ,as it passes
through the rubbery stage it tends to get lifted from the cavity.
remove the excess cement only when it is hard.
Polycarboxylate cement adheres to the
instrument, so
1.Use alcohol as release agent for mixing.
2.Instrument should be cleaned before setting.
3.From spatula it can be chipped off.
remaining material is removed by boiling in
sodium hydroxide solution.
 Removal of excess cement
•If done during rubbery stage
•If delayed till cement sets
•Preferred way
 Use as luting agent
•For use as Luting agent the surface of the tooth
and the indirect restoration should be
thoroughly clean to enable good chemical
adhesion.
•Failure usually occurs at cement metal
interface rather than at cement tooth interface
as with zinc phosphate cement
•The surface of metal restoration should be
sand blasted to improve retention
 APPLICATIONS

1) Luting of permanent restorations

2) Bases and liner
3) Luting of orthodontic bands and
brackets
4) Masking agent under thin enamel to
prevent metallic restoration from seen
through
 Zinc oxide eugenol
• Said to be one of the least irritating
cements and said to have a palliative
effect on pulp
• Used for many purposes
• Different modifications
 Different types
ADA specification no 30
Type I – temporary cementation
Type II – permanent cementation(or long
term luting agent)
Type III – temporary filling material
Type IV – cavity liners
 Commercial formulations
 Unmodified - Temp-Bond ,Flow Temp,
ZOE 2200
 EBA Alumina modified- Optow Alumina
EBA, Super EBA
 Polymer modified – Fynal, IRM, Cavit
 Non eugenol – Neogenol, Freegenol ,Zone
 Composition
Powder Liquid
Zinc oxide 69% Eugenol 85%
White rosin 29.3% Olive oil 15%
Zinc Stearate 1 %
Zinc acetate 0.7%
Magnesium oxide
 Setting reaction

ZnO + H2o Zn(OH) 2

Zn(OH) 2 + 2 HE ZnE2 + 2 H2o

 Structure of set cement
 The set cement consists of unreacted
particles of zinc oxide embedded in a
amorphous matrix of zinc eugenolate

Setting time – 4- 10 minutes

 Factors affecting setting time
 Alcohol, glacial acetic acid and small
amounts of water accelerate setting
reaction
 Heat accelerate setting whereas lower
temp like cooled glass slab slows the
reaction
 Glycol and glycerin retard the setting
reaction
 Properties
 Compressive strength – range of 3 to 4
Mpa upto 50-55 Mpa
 Tensile strength -0.32 to 5.8 Mpa
 Modulus of elasticity -0.22 to5.4 Gpa
 Thermal conductivity- 3.98 cal/sec/cm2
 Solubility & disintegration – 0.04 % wt
 Film thickness – 25 micro meter
 Biological properties –

pH – 6.6 to 8
Bacteriostatic
Anodyne or soothing effect on pulp
 Pulp reaction
 Cell culture – more severe reaction than
silicate cement at 30 days but slight
difference between two at 90 days
 But in class V usage test the results are
different.
-
 Class V usage test
slight to moderate infection within first week
-mild chronic inflammatory reaction with
some reparative dentin formation was
seen at end of 5 to 8 weeks.
Hence used as a negative control in usage
test to check reactions of the pulp to
cements.
So it is indicated in cases where intact
dentin is present
Microleakage
ZOE is bacteriostatic. Hence it is used to as
an overlap to eliminate microleakage that
is as a surface seal restoration.( e.g.
Cavit)
 Manipulation
Powder liquid system
• P/L ratio : 4:1 to 6 :1 by weight
• measured quantity of both dispensed
• Bulk of powder incorporated
• Smaller increments added to adjust the
mix
• Oil of orange used to clean the cement
from instruments
Oil of Orange
Paste paste formulation
• equal lengths of each paste are
dispensed on the glass slab.
• they are mixed till a uniform colour is
obtained to ensure through mixing.
zinc oxide eugenol cements set quickly in
the mouth due to moisture and heat
Cementation
 But eugenol can soften the provisional
acrylic resins
 Also the setting reaction of resin cement is
inhibited by eugenol
 Hence it is contraindicated for use under
resin composites
 Modified zinc oxide eugenol
cements
 EBA Alumina modified cements
 Polymer reinforced zinc oxide eugenol
cements
 Non zinc oxide eugenol cements
 Special zinc oxide eugenol cements
EBA Alumina modified cements
 Introduced to improve mechanical
properties
 Powder – zinc oxide and alumina
 Liquid – Ethoxy Benzoic Acid 62.5% and
eugenol 37.5%
 In general they have better properties than
that of unmodified ZOE
 Properties
 Compressive strength -55 Mpa
 Tensile strength – 4.1 Mpa
 Modulus of elasticity – 2.5 Gpa
 Film thickness – 25 micrometers
 Solubility and disintegration – 0.05 % wt
 Setting time – 9.5 mins
 Polymer reinforced ZOE
 The powder contains 20 to 40 wt% of fine
polymer particles(PMMA)
 The zinc oxide particles are also surface
treated with carboxyllic acid.
 Both this modifications lead to improved
abrasion resistance and strength
IRM
INDICATIONS
 IRM® is a reinforced zinc oxide-eugenol
composition for intermediate restorations
lasting up to one year.
 It can also be used as a base under non-
resin restorations.
 CONTRAINDICATIONS
 IRM® is contraindicated for use with patients
who have a known
 hypersensitivity to eugenol or acrylate resins.
 IRM® IS CONTRAINDICATED AS A BASE
under resin restoratives because eugenol may
interfere with the hardening and/or cause
softening of the polymeric components
Cavity Preparation
1. Cavity preparation must provide for the
mechanical retention of the material.
2. Isolate field of operation in usual manner.
3. Dry cavities with cotton; avoid prolonged
air-drying.
4. In all deep preparations (close proximity
to the pulp), use a thin layer of Dycal®
calcium hydroxide composition.
Cavit
 Cavit

* filling material for temporary fillings.

*Simple to apply with filling instrument.
*Quick and void-free curing in a moist
environment.
*Slight expansion of the filling material
ensures a well-sealed margin.
• Cavit (high surface hardness):
Temporary filling of occlusion-loaded restorations
• Cavit-W (reduced final hardness, increased
adhesion):
Temporary filling after endodontic treatments
• Cavit-G (removable completely without burs):
Inlay-preparation
 Instructions for Use

 Apply Cavit in moist cavity

 Avoid any exposure to mastication forces
for about 2 hours after application
Zinc oxide non eugenol
cements
Indications
1) Patient is allergic to eugenol
containing products
2) Beneath acrylics and composites
3) If permanent cement is resin-
based
Temporary NE bonding
Non eugenol cement
 Directions for Use

 Extrude equal lengths of Base and Accelerator onto the

mixing pad. The length to be extruded will depend on the
size and type of restoration to be cemented.
 Dry the tooth and the surface of the restoration
 Thoroughly mix the pastes for approximately half a
minute. Spread a thin layer of cement over all areas
which will contact the prepared teeth.
 Firmly seat the restoration in the mouth
 After the Temp-Bond has set (approx. 2 minutes in the
mouth) trim away excess.
 Replace cap tightly on the tube after use.
 Store at normal room temperature and humidity
 The non eugenol zinc oxide cements do
not adhere as well to preformed metal
crowns as the eugenol containing cements
abd they are slower setting
 However they do not soften the provisional
acrylic crowns.so can be used under
composites
 Special cements
 Products are added to zinc oxide cement
for therapeutic benefits
 Tetracycline , steroids as anti inflammatory
agents
used in pulp capping and root canal therapy
 Zinc oxide eugenol based sealers
Mainly two major groups of ZOE cement
 Conventional sealers
 Therapeutic sealers
 Conventional sealers
Rickert’s formula Grossman ‘s formula
 Powder % Powder %
 Zinc oxide 41 Zinc oxide 42
 Silver 30 Staybelite resins 27
 White rosin 17 Bismuth subcarbonate 15
 Thymol iodide 12 Barium sulfate 15
Liquid Sodium borate 1
 Oil of cloves 78 Anhydrate
 Canada balsam 22 Liquid
Eugenol 100
 Conventional sealers
 Based on formula of Grossman or Rickert.
 The setting reaction occurs between zinc
oxide and eugenol. resins improve the
mixing characteristics and retard setting.
 Radiopacity is improved by adding barium
or bismuth salts or silver powder.
 They are used with silver filling points.
 Therapeutic formula
 Powder –zinc oxide, bismuth subnitrate,
iodoform, rosin
 Liquid –eugenol, cresoate, thymol
 They are usually used without a core
material and are formulated with ingredients
such as iodoform, paraformaldehyde or
trioxymethelene ,which may have
therapeutic value.
 Paraformaldehyde toxicity
 N2 and RC2B are examples of
paraformaldehyde containing ZOE based
sealers which were popular earlier.
 But studies showed that they were
suceptible to dissolution and causing
release of paraformaldehyde in periapical
tissues leading to severe tissue reaction.
 ANSI’ADA specification no 57
for endodontic sealing materials
1993

 Requirements for type II and III endodontic

filling materials.
 Working time : + or – 10% of
manufacturer’s claimed value
 Minimum flow: 20 mm
 Maximum film thickness: 50 micrometers

 Setting time : + or – 10% of

manufacturer’s claimed value
 Maximum Linear Dimensional change at
30 days(%) : 1.0 shrinkage or 0.1
expanmsion
 Maximum solubility: 3.0%

 Minimum radiopacity 3.0 mm of alumimum

 Viscosity : ability of a sealer to penetrate
into irregularities and accessory canals.
 Setting time ranges from 15 minutes to 12
hours at mouth temperature. They set
more rapidly at mouth temperature than at
room temperature.
Glass Ionomer cement
 Contents
• History of Glass-Ionomer Cements
• Classification
• Composition
• Setting reaction
• Structure of set cement
• Manipulation
• Physical Properties
• Modifications
• Bonding Glass-Ionomer Cements to Tooth Structure
• Clinical Applications
History
 DEVELOPMENT
Timeline for “direct restorative materials” usage
Timeline for “direct restorative materials” usage

First GIC in 1972 A.S. = Aluminosilicate glass

Dentsply A.S.P.A. P.A. = Polyacrylic acid in water

1970 1980 1990 2000

Dental Amalgam

Dental Composite
Glass Ionomer
 Evolved as a hybrid from silicate &
Polycarboxylate cement

ZnO

ZPC PCC

Phosphoric acid Poly acrylic acid

e
at
lic
GIC

Si
Silica

“Man made Dentin” “Dentin substitute”

117
 Definitions & Terminology
 Poly alkenoate cement ; GIC ;
ASPA ( Alumino Silicate Polyacrylic Acid )
 Glass – ionomer
refers to a material in which an acid base
reaction contributes to a setting process which takes
place within a clinically acceptable time ( few min ).

118
 Classification(Mclean)
 Type I : Luting crowns, bridges and
orthodontic brackets
 Type II a : Aesthetic restorative cements

Type II b : Reinforced restorative

cements
 Type III : Lining cements, Base.
Classification ….

 According to application:
 Type I - Luting cements
 Type II – Restorative cements
 Aesthetic filling materials
 Reinforced material
 Type III – Lining cement
 Type IV – Fissure sealant
 Type V – Orthodontic cement
120
 Type VI – Core build up
NEWER CLASSIFICATION
1.TRADITIO NAL GLASS IONOMER
 A.TYPE I – LUTING CEMENT
 B. TYPE II – RESTORATIVE CEMENTS
 C. TYPE III – LINERS AND BASES
2. METAL MODIFIED GLASS IONOMER
 A. MIRACLE MIX
 B. CERMET CEMENT
3. LIGHT CURE GLASS IONOMER HEMA ADDED TO LIQUID
4. HYBRID GLASS IONOMER
A. COMPOSITE RESIN IN WHICH FILLER SUBSTITUTED WITH
GLASS IONOMER PARTICLES.
B. PRE-CURED GLASSES BLENDED INTO COMPOSITES
 Composition
Powder
 Silica(SiO2) 41.9%
 Alumina(Al2O3)- 28.6
 Calcium Fluoride (CaF2) 15.7
 Sodium Fluoride (NaF) 9.3
 Aluminum phosphate(AlPO4) 3.8
 other metals like strontium, barium or
lanthanum provide radiopacity
 Manufacturing of powder
The components of the powder are fused to
a uniform glass by heating them to a
temperature of 1100 degrees to 1500
degrees C.
The glass is ground into a powder having
particles in the range of 15 – 50 micro
meter.
 Liquid

 Polyacrylic acid Acrylic

 Tartaric acid
 Water Itaconic

Maleic
 Setting reaction

Fluroaluminosilicate glass + polyacid

polyacid matrix (salt)

 Glass ionomer cement (GIC)
reaction
Fluoride - releasing
H H reactive glass H H
C C or hydroxyapatite in C C + F-
H C=O tooth structure H C
OH O O n salts
n -
Polyacrylic acid
low flexural strength
Water

Counterions crosslink
polymer, glass and
tooth structures -
 GLASS IONOMERS
HYBRID = SC [Powder] and PCC [Liquid] = A.S.P.A.

H2O Si+4
PAA
SiO2, in Al+3
SiO2, Na+
Al2O3, H2O
Al2O3, Ca+2
Na, Ca,
Na, Ca, F-
F
F PAA

Residual Glass Particle

SiO2, POLYACRYLATE HYDROGEL
Al2O3, (initially Ca polyacrylate gel
Na, Ca, and later Al polyacrylate gel)
F
Si+4, Al+3, Ca+2, Na+, F- Ions
GI SETTING REACTIONS
Ca+2 Al+3
H-O-H
F- Si+4
--O-Si+4(OH)2
¯OOC F-Al-SiO2
COO¯ CaF2 H-O-H
COO¯
Ca+
H-O-H
¯OOC COO¯
COO¯

¯OOC

COO¯ H-O-H
Ca++
¯OOC
Ca+ ¯OOC
COO¯
¯OOC
¯OOC
¯OOC COO¯
Al+3
COO¯
H-O-H
 Acid attacks the surface particles.
 Various ions leached
 Early stage
 Secondary reaction stage
 Sodium and fluoride ions do not react with
the polyacid
 fluoride bonds with hydroxyappatite
 The water component of the cement is
impotant for strength of the set structure.
 Loosely bound water(prone to dessication)
 Tightly bound water
 FLUORIDE RELEASE
Fluoride comes from matrix and particles at different rates.
Fluoride comes from matrix and particles at different rates.

rapid early
F release
from matrix
Slow long term
F release
by diffusion
from particle

F-1,
Ca+2, Al+3, Si+4

Initial
dissolution
for
starting
reaction

FLUORO-ALUMINO-SILICATE CEMENT
PARTICLE MATRIX
 Factors Influencing the rate of setting

 Glass composition
 Particle size of glass powder
 Addition of tartaric acid
 Relative proportions of the mix
 Effects of Tartaric Acid

 Improve handling characteristics,

 increases working time,
 decreases viscosity
 Shortens setting time
 Role of water in reaction
 Serves as the reaction medium initially
 Then hydrates the cross linked matrix
 Amount of water
 Mechanism of adhesion

Primarily involves chelation of carboxyl

groups of polyacids with calcium ions of
apatite.
Bond strength higher with enamel
 Structure of set cement
The set cement consists of agglomeration of
unreacted powder particles surrounded a
by silica gel in an amorphous matrix of
hydrated calcium and aluminum polysalts.
 Properties
 Mechanical properties
Compressive strength : 150 Mpa
Tensile strength : 6.6 Mpa
Hardness : 48 KHN
Fracture toughness: 0.88 MPa/sq.metre
 Solubility and disintegration
 Initial solubility is high.
 Hence should be protected from
dessication.
 After initial set, solubility decreases.
 Solubility after intial set:0.4%
 Esthetics
 Inferior to silicates and composite.
 Lack translucency
 Rougher surface texture than composites
 Biocompatiblity
 Relatively biocompatible
 Pulp reaction classfied as mild
 Reaction is more than ZOE but less than
zinc phosphate.
 In deeper cavities, apply calcium
hydroxide sub base
 Not to be placed directly over the pulp
 Anticariogenic effect

It is mainly attributed to release of

fluoride from the set cement
Release is comparable to silicate
cement.
Zone of resistance to demineralisation
of at least 3 mm adjacent to the cement
 CARIOSTATIC EFFECTS
GI is not more effective than composite or amalgam.
GI is not more effective than composite or amalgam.

Glass Ionomer

Composite

Amalgam

0 20 40 60 80 100
Replacement rate (%) for secondary caries

Mjor IA. Glass ionomer cement restorations and secondary caries: a

preliminary report. Quintessence Int 1996;27(3):171-174.
1996;
 Manipulation
 Conditioning of the tooth
 Proper manipulation or mixing
 Protection of the cement during setting
 Finishing
 Condtioning of tooth
 Tooth surface should be clean to improve
adhesion.
 First the tooth should be cleaned with
pumice slurry
 Then 10-20% polyacrylic acid is applied to
the tooth for 10 to 15 seconds
 Proper manipulation or mixing
 p/ l ratio given by manufactuer should be
followed
 A paper pad should be used
 The powder and liquid should be
dispensed just before mixing
 Mixing time :45 to 60 seconds
 Plastic spatula is to be used for mixing
 Finishing
 Finishing and polishing procedures
depend on the type of glass ionomers
restorative type.
 However the smoothest finish is produced
when the material is allowed to cure
against an acetate strip.
Modifications and Recent
advances of GIC
 Hydrophobic POLYMER

GIOMER COMPOMER COMPOSITE

 VLC Composite and  VLC Composite and
 Pre-reacted GIC powder  F source Universal
Universal
CEMENTS CEMENTS
FILLING MATERIALS FILLING MATERIALS FILLING MATERIALS

RM-GI
 GI and
 VLC Hydrophilic
monomer and polymer

CEMENTS

MM-GI GI RR-GI
 GI and  GI and
 Metallic fillers  Resin-Fillers
 Cermet fillers
A.R.T. and
CORES TEMPORARIES
HYDROGEL
 Modification and advances in
GICs
 Metal modified GIC
 Resin modified GIC
 Poly acid modified GIC (compomer)
 Highly viscous GIC
 Fast setting GIC
 Type II.1 dual cure (Fuji II LC)
 Immediately after light curing,finish with
graded fine diamond or tungsten carbide
burs with air/water spray at low speed.
 Polish with either graded rubber polishing
points with air water spray or polishing
discs with lubricant (e.g Fuji coat LC)
without water spray at low speed.
 Seal restoration with low viscosity resin
and light polymerise
 Metal modified GIC
 Conventional GICs lacked toughness and
cannot withstand high stress concentration
that initiate crack propagation.
 Hence in 1985,metal modified gic were
introduced.
 Metal modified GIC
Mainly of two types
1) Physically incorporating silver alloy
powder with glass powder(miracle mix)
2) Fusing silver particles to glass powder by
sintering (cermet)
Miracle mix
 Miracle mix
 Powder particles were reduced in size and
amalgam alloy powder (Ag-Sn) were
incorporated for reinforcements.
 Marketed as amalgam substitutes.
 Miracle-mix mixtures
 Hg controversy was increasing then
 Miracle mix
 However properties of miracle mixtures
were quite inferior to amalgam.
 Matrix of GIC was not strongly adhering to
silver-tin particles.
 Hence not well received as restorative
material
 Cermet
 Silver palladium sintered to along with
glass.
 Ag-Pd generate a passivating film of PdO
that is chemically reactive by chelation
with polyacrylic acid.
 Ceramic-metals
 General properties
 Little increase in mechanical properties of
GIC.
 Flouride release is appreciable but
decreases substantially over time.
 Not esthetic
 Hardens rapidly & can be finished in short
time
 Compressive strength – 150 Mpa
 Diametral tensile strength –6.7 Mpa
 Hardness- 39 KHN
 Fracture toughness
1. Cermet –0.51 Mpa/sq.met
2. Metal reinforced GIC (Miracle Mix) –0.30
 Clinical applications
 Used mainly for core build ups
 Not to be used wherever cement will
constitute more than 40% of total core
build up
 Made redundant by introduction of high
viscosity GICs
Poly Acid -modified composites
or Compomer cement
Permacem,Dyract
AP,Composglass,F2000
 Term poly acid modified resins was
suggested by Mc Lean et al.
 They have no significant acid base
reaction
 Attempt to provide benefits of flouride
release of GICs and durability of
composites.
Poly Acid -modified composites
(compomers)
 Consist of
 Silicate glass particles,sodium flouride
 acidic hydrophobic methacrylate
monomers without water

 Setting reaction
 monomer polymerisation
 limited acid /glass reaction (catalysed by
water sorption)
• Available as one paste component or a
powder and liquid formulation.
• The flouride release is because of the acid
base reaction which occurs when the set
material begins to absorb water in the
saliva.
• Quite low compared to conventional GIC
 Fluoride release
6

Fuji II LC
Fluoride concentration

(original)

Dyract
0
0 5 10
Time (days)
There is no water originally present in the
structure
Filler is partially silanised.
It does not adhere to the tooth.
Separate dentin bonding agent is
required.
 Main advantages
 reasonable strength
 low fluoride release

 Main disadvantages
 Require adhesive
 polymerisation shrinkage
 Decreased wear compared to composites
 Fast setting lining cements
 Discovered by Wilson and Crisp in 1972.
(BDJ’ 1988) .
 optically active d-tartaric acid modified
the cement reaction
 E.g Photac-fil quick,Fuji IX fast set, Ketac
molar quick
Thus showing improved
 Handling characteristics
 Increased W.T.
 Decreased S.T
 Enabled the F context of glasses to be
decreased.
 Increased strength.
High viscosity conventional GIC
 Also called packable (condensable) GIC
 Developed in early 1990s primarily in
response to ART
 E.g. Chemflex (Dentsply), Fuji IX GP,
Ketac Molar , Hi Dense
 More easily handled than conventional
GIC
 Atraumatic
Restorative Treatment (ART).
This is a procedure based on excavating
carious
dentin in teeth using hand instruments only
and restoring the tooth with adhesive filling
materials (tooth restoration without rotating
instruments in third world nations).
• Glass ionomer, because of its adhesiveness
and release of fluoride, is the natural choice to
fill that gap.
• In this technique glass ionomer cement is
pressed in to the excavated tooth cavities and
pits and fissures .
• The relatively higher viscosity is the result of the
addition of polyacrylic acid to the powder and
finer grain – size distribution.
The same glass ionomer technology was
developed for anterior restorative for ART.
One such product is Fuji VIII. It is a resin
reinforced glass ionomer restorative for
anterior teeth where higher flexural
strength and better translucency is
required.
 General properties
 Biocompatibility and Fl release similar to
conventional GIC
 Improved tensile and abrasion resistance
 Increased wear resistance
 Adheres to tooth
 Satisfactory esthetics
Main indications of GIC
 Resin-modified
glass-ionomer cements
Coventional GICs had two main problems
Moisture sensitivity and low early strength.
Hence polymerizable functional polymers were
added to it to improve on this properties.
 Resin-modified glass-ionomer
cements (RMGICs)
Powder
 Fluroaluminosilicate glass
 Initiators for light and/or chemical curing

Liquid
 polyacrylic acid
 HEMA (hydrophillic monomer)
 water
 Initial setting reaction occurs by
polymerization of of methacrylate groups
 The slow acid base reaction will be
responsible for the unique maturing
process and final strength.
 Termed dual cure , tri cure.
 E.g. Fuji II LC(GC), Photac-Fil and
Vitremer(3M ESPE)
 Properties
Type II GIC RMGIC

Compressive 150 MPa 105 MPa

strength
Diametral 6.6 MPa 20 MPa
tensile strength
KHN 48 40
 Higher bond strength than conventional
GIC
 Increased translucency
 Same fluoride release levels
 Greater setting shrinkage
 Advantages
• Greater working time,
• Command set on application of visible light
• Good adaptation and adhesion
• Acceptable fluoride release
• Aesthetics similar to those of composites
• Superior strength characteristics.
 Disadvantages

• Polymerisation shrinkage
• Monomer toxicity (HEMA)
• Lower depth of cure
 Uses
 Liner and bases
 Class V and class III restorations
 Abrasion,erosion,root caries
 Core buildups
 Class I and II in deciduous teeth
 Micro cavities and tunnel preparations
 Applications of gic
 As luting cement
 In restorative dentistry
 In Endodontics
 According to application:

 Type I – Luting cement

 Type II – Restorative cement
 Esthetic filling materials
 Reinforced materials (Fuji IX etc.)
 Type III – lining cement
 Type IV – fissure sealant
 Type V – Orthodontic cement
 Type VI – Corebuilding cement
 APPLICATIONS
GI have been tried for about every conceivable application.
GI have been tried for about every conceivable application.

1. Cement
2. Liner / Base
3. Restoration
4. Core / Foundation
5. (Tunnel Restoration)
6. (Sandwich Restoration)
7. Retrograde Filling Material
8. P/F Sealant
9. Root Caries Cervical Restoration
10. Temporary, or ART Restoration

Technical modifications: General Properties:

> P/L  Precapsulated > Strength
> Addition of etching and then BA > Adhesion
> Addition of different reinforcing fillers > Biocompatibility
> Finer and finer particle sizes > Fluoride release
 Luting cement requirements
Ease of use
adequate working time
ease of seating;low film thickness
ease of removal of excess cement
Biocompatibility
non irritating to pulp and periodontium
optimum sealing ability
no systemic toxicity
Physical attributes
adequate strength, rigidity and toughness
insoluble in oral fluids
adhesion to tooth structure and restoration
Glass ionomer luting cement
 Glass Ionomer Cement + Resin

 RelyX Luting cement

 hybrid glass ionomer
permanent cement
 the new name for
Vitremer Luting
cement
 GIC in endodontics
 GIC was first used as a root canal sealer
by Pitt Ford.
 Stewart mixed together two GIC formulae
and then added BaSO4 to increase
radiopacity.
 Ray & Seltzer filled root canals entirely
with modified GIC and concluded that it is
easy to use adequately radiopaque and
adapted well to canal wall.
 Saunders et al used Vitrebond as sealer in
conjunction with gutta percha and found
that it closely adapted with canal walls.
 Trope and Ray suggested that roots filled
with GIC has increased resistance to
vertical fracture
 Retreatability and removal
 GIC sealer is placed with GP cone.
 So if retreatment is required then GP cone
can be dissolved and the sealer is
removed by ultrasonic vibration.
 Slower to remove compared with
conventional sealer, but can be removed
effectively.
 Preparation of post space is also slower
 Sealing efficacy-the results of various
studies remain diverse and inconclusive
 When smear layer is removed, GIC was
seen to penetrate the tubules but less
compared to other sealers.
 GIC persists in the tissues when extruded
periapically. This confirms its low tissue
solubility
 Retrograde filling
 RMGI and MMGIC were tried for
retrograde filling.
 The main obstacle in clinical application of
GIC as retrograde filling is difficulty of
isolation of surgical field.
 It is found that bone grows directly over
GIC without any interface of connective
tissue or inflammatory tissue.
 Other endodontic uses
 Perforation repair
 Treatment of vertical fractures
 Coronal sealing after RCT
 GIC in restorative dentistry
 Liner/Base
 Temporary restorations
 Sealant and preventive restoration
 Permanent restorations
 Liner / Base
 The primary purpose of GIC liner is to
serve as intermediate bonding material
between tooth and composite.
 GIC advantages over DBA
 A proven adhesive bond,
 Reduced technique sensitivity
 Established anticariogenic effect by
fluoride release
 Sandwich technique
 Combines desirable qualities of GIC and
aesthetics of composite restoration
 It involves replacing the lost dentin with
GIC and lost enamel with resin composite
 Either conventional or light curable GIC
can be used.
 To act as a elastic buffer,the liner must be
applied in thickness of at least 0.4 mm in
class V and 1.5- 2 mm in class II cavities
 Types of sandwich techniques
 Open technique – here the GIC is exposed
to gingival margin
 Closed technique- Here GIC is completely
covered by resin composite.
 The difference between two
 In cases with poor oral hygiene,to diminish
the risk of dissolution an external coating
of DBA can be applied or external wall
with resin composite can be created-
Centripetal build up technique
 Temporary restoration
 Emergency replacement of lost filling
 Emergency repair of fractured tooth
fragment or cusp
 Restoration of endodontic access/walking
bleach preparation
Sealant and preventive restoration
 Ability of GIC to bond chemically to dentin and
enamel without the use of the acid-etch
technique (Aboush et al, 1986), which makes
them less vulnerable to moisture.
 This, in conjunction with active fluoride release
into the surround enamel (Komatsu et al, 1986),
has led to the development and evaluation of
GIC as an alternative fissure sealant system,
particularly in cases where moisture control is
difficult to achieve.
 Studies of the use of GIC (Raadal et al, 1996; Boksman
et al, 1987; Forss et al, 1992), and resin modified glass
ionomers (Smales and Wong 1999) as fissure sealants
indicate significantly lower retention rates than resin-
based pit and fissure sealants.
 However, several studies have found that GIC’s exert a
cariostatic effect even after they had disappeared
macroscopically, and that this effect might be based on
remnants of the cement in the fissure as well as
increased levels of fluorides on the enamel surface
(Williams and Winter, 1981; Shimokobe et al, 1986;
Ovrebo and Raadal, 1990; Skartveit et al, 1990; Mejare
and Mjör, 1990).
• Glass ionomer cements should be used in
cases where moisture control is difficult,
e.g. in erupting or newly erupted teeth.
• GIC sealants in these cases are regarded
more as a temporary sealant or a fluoride
release vehicle, rather than a true fissure
sealant.
 Patient and tooth selection

1) Children and young people with medical, physical or intellectual

impairment: The application of sealant to all susceptible sites of primary
and permanent teeth should be considered, especially when systemic
health could be jeopardised by dental disease or the need for dental
treatment.
2) Children and young people with signs of acute caries activity: All
susceptible pit- and fissure sites should be considered for sealing
including the buccal fissures of permanent molars
3) Children and young people with no signs of caries activity: Only deeply
fissured (extremely plaque retaining fissures) and thus potentially
susceptible surfaces should be considered for sealing.
 Steps of sealant placement
 Isolation of the tooth

 Conditioning with 10%

polyacrylic acid

• Drying the tooth

 Fuji III (Fuji Triage ) syringed

 Light curing for 40 seconds

 After curing
 If there is unequivocal evidence that the lesion is
confined to enamel then the surface can be sealed and
monitored clinically and radiographically.
 When the evidence is equivocal, then removal of the
stained areas in the fissures (enamel biopsy) should be
performed, using rotating instruments.
 If the lesion extends into dentine after removal of
staining then a sealant restoration ("preventive
resin/glass ionomer restoration") may be placed.
 A more extensive cavity will require a conventional
restoration
 Permanent
restorations
 Class III cavities
 Class V cavities
 Small to moderate class I and class II
restorations
 Core buildup
 ART
Class III restorations
Class V restorations
Core buildup
Small to moderate class I and
class II
Atraumatic restorative treatment
 Developed in Tanzania in mid 1980s and
introduced in clinical settings in early
1990s
 Need – to provide comprehensive oral
health care combining restorative &
preventive t/t to a greater part of world
population that has no access to oral
health care.
 Technique
 Removal of caries is achieved with hand
instruments.
 The tooth is conditioned and restored with
glass ionomer cement.
 Fuji 8 and Fuji 9,Ketac molar are
especially formulated for this purpose.
 Now fast setting versions of all three are
also available
Potential application in modern
practice
 Nervous patients
 Patients with medical / physical disability.
 Children
 Stabilization of caries in patients with
multiple lesions.
 Emergency visits to surgery / home
visits.
 Educational programmes.
 Advantages:
1) No threatening dental equipments.
2) Technique is biologically friendly and
conserves sound tooth tissue.
3) Readily available which can be taken to
everyone
4) LA not always required.
5) Exploits the beneficial property of GIC
6) Ease of repair of restorations
 Disadvantages
1) Questionable long term survival of GIC.
2) Hand mixing way alter p/l – weaker
restorations.
3) Average time per tooth ~ 20 minutes –
Hand fatigue.
4) Inadequate removal of caries by
inexperienced operator – Unintentional
neglect
 Resin cements
 Have become popular as luting agent in
recent times
 Are essentially flowable composites of low
viscosity
 Composition
 Resin matrix
 Silane treated inorganic filler
 Adhesive monomer- HEMA, 4-META, and

10-methacryloyxydecamehtylene
phosphoric acid (MDP)
 Resin Cements
 Types
 chemical / auto-cure
 visible light cure
 dual (chemical and light) cure
 Resin Cements Properties
 Types
 Powder liquid
 Paste paste
 Resin Cements Properties
 Advantages
 high strength
 low oral solubility
 High adhesion
 Good esthetics
 Disadvantages
 Technique sensitivity
 Requires use of separate primers or
adhesives
 possible leakage + pulp sensitivity
 difficulty removing excess cement
 Occasional post operative sensitivity
 Expensive
 Commercial formulations
 Calibra DENTSPLY Caulk
 DUO-LINK Bisco
 Maxcem Kerr Corp.
 PANAVIA F2.0 Kuraray America, Inc.
 RelyX Unicem 3M ESPE
 Ultra-Bond Plus DenMat
 Variolink II Ivoclar Vivadent
 Panavia cements
 Panavia Ex
 Panavia 21
 Panavia F 2.0
 Panavia Ex
 Anaerobic curing resin
cement

 Cures only after oxygen

is cut off
 Panavia 21

Anaerobic curing
cement
Comes with self
etching primer
 Panavia F 2.0
 Light and anaerobic
curing
 Fluoride releasing
Panavia F 2.0
Panavia Ex and Panavia 21
Manipulation
 Indications

3M™ ESPE™ RelyX™ Unicem Self-Adhesive Universal

Resin Cement is a selfadhesive universal resin cement
for adhesive luting of:
 Inlays
 Onlays
 Bridges
 Crowns
 Posts and screws (including fiber posts) made of metal,
composite and ceramic.
 RelyX Unicem self-adhesive universal resin cement is
dual-curing.
 Summary
 We have a large range of choice for diverse
applications in cements, each having its own
advantages and disadvantages
 The choice of cement to be used for a specific
purpose is based on its mechanical ,
chemical ,biological properties as applicable to
the specific requirements-liner,base,luting
agent,restorative material
 Bibliography
 Science of dental materials-Anusavice
 Restorative dental materials-Craig
 Glass Ionomer cements –Wilson and Kent
 Advances in glass Ionomer cement-
Davidson and Mjor
 Sturdevant
 Summitt