Advanced Cementation Update Webinar

Clinical Mastery (www.clinicalmastery.com) Over-the-shoulder Prepless veneer courses Full mouth rehabilitation courses Hands-on Occlusion Courses Webinars Phoenix, Arizona

Webinar October 14th The Why, Where, & When of bite relationships John Nosti, DMD www.clinicalmastery.com

david@hornbrook.com

Cementation Adhesion Semi-adhesion Non-adhesion “total-etch”, resin cement Semi-adhesion Self-etching resin cement Non-adhesion Glass Ionomer, resinionomer, zinc phosphate, polycarboxylate

Cement Requirements Lack of post-operative sensitivity Strong bond and good seal -to the tooth and to the restorative material Easy placement and clean-up Esthetics compatible with the restorative material Minimal film thickness Radiopaque (posterior)

Powder liquid ceramic or Pressed ceramic restorations “Total-etch” with Resin Cement Powder liquid ceramic or Pressed ceramic restorations

“Tack & Wave” Cementation Veneers and anterior crowns

Emprethin evaluation

Be Careful!!! 0.2 mm glass is fragile!

OptraGate (Ivoclar)

Hydrogen Peroxide in Ultradent Syringe

Metal strip removes any interproximal Luxatemp and freshens the enamel

Try in independently DRY

Occlude Spray Powder (Pascal)

Try-in collectively DRY! Check complete seating Proximal contacts

Mesial Surface Dry Erase Marker

Distal Surface

Variolink Veneer (Ivoclar/Vivadent) Value based +1, +2, +3 -1, -2, -3 Microfill

+2

Clean and acidify with 35% Phosphoric acid

Silane Coupling Agent (Relyx Ceramic primer) placed for 1 minute

Place bonding agent (All Bond 3) inside dry restoration

Load restoration with resin cement

Vivapad (Ivoclar)

Etch with 35% phosphoric acid for 15 seconds per tooth

Apply Systemp desensitizer for 15 seconds

Effect of Remoistening Water vs. Desensitizer/Rewetting Agent Product Dentinal Bond Water-blotted dry 22.8 Water- wet 19.2 Gluma Desensitizer 22.3 HurriSeal 20.1 Vivadent Desensitizer 25.8 MicroPrime 20.1 Aqua-Prep 18.1

“suction” away excess; do not desiccate

Apply 2 coats of All Bond 3 A & B Primer mix

Adec Warm Air Tooth Dryer

Seat all restorations at one time; do not remove excess resin cement

Polymerize “dead center” each restoration for 1 second using a 2 Polymerize “dead center” each restoration for 1 second using a 2.0 mm light guide (Ivoclar)

Hold light guide 1 inch from restorations and light cure 3-5 seconds on facial and lingual

General Guidelines +2: 5 seconds 0: 3 seconds -3: 5 seconds +

“Pick" away excess using Bard Parker or scaler

Floss through contacts using a Brasseler Serrated Saw

Floss through contacts using waxed dental floss

Place DeOx (Ultradent) on all margins

Light polymerize for at least 60 seconds per tooth from both buccal and lingual

Curing Lights Photoinitiators Camphoroquinone- 470-490 nm PhenylDipropandione- 430 nm

PDP 430 nm CQ 488 nm Wavelength (nm)

Emits light with wavelength OptiLux 501 (Demetron) Emits light with wavelength 390-510 nm

PDP 430 nm CQ 488 nm Wavelength (nm)

-Wavelength output 450-500 nm LED Light i.e.. Freelight (3M), LEDemetron (Kerr),,BluPhase (Ivoclar), DEMI (Kerr)… -No bulb degradation -Portable -Wavelength output 450-500 nm

PDP 430 nm CQ 468 nm Wavelength (nm)

Emits light with wavelength 390-510 nm BluePhase G2 (Ivoclar)

Fusion www.dentlight.com

Remove excess resin cement with Scaler, #12 & #15 Bard-parker Blades

Run Serrated Saw through contacts

1954N Strip (3M)

Epitex Strips (GC)

15 micron finishing diamond (Brasseler))

15 micron football-shaped diamond on lingual

OptraFine Porcelain polishing system (Ivoclar)

DiaShine ( V & H )

Solid Model Contacts

Adhesion to the restoration Ceramist etches in lab Clinician cleans internal surfaces with phosphoric acid Rinse and dry thoroughly Apply Silane coupling agent Apply dual-cure adhesive resin to internal of restoration

Adhesion to the restoration Ceramist etches in lab Clinician cleans internal surfaces with phosphoric acid Rinse and dry thoroughly Apply Silane coupling agent Apply dual-cure adhesive resin to internal of restoration

Blot Dry dentin

Apply primer

Air dry primer

Light polymerize for 10 seconds

Posterior RelyX ARC (3M)

Hold passively for 3 minutes

Remove excess with scaler or explorer

Floss through contacts

oxygen-inhibiting medium Cover margins with oxygen-inhibiting medium

Light polymerize for at least 60 seconds

Use scaler and/or #12 Bard Parker

Core-reinforced Restorations Lithium disilicate (e.Max) Zirconia Alumina Metal Lithium disilicate (e.Max)

“Core” reinforced ceramic (Metal, zirconium, lithium disilicate, alumina oxide) Pressed Ceramic/ Powder-liquid ceramics High technique sensitivity Conventional cements No etch Adhesive cements “Total-etch” resin cements

Lithium disilicate pressed e.Max Pressed Lithium disilicate pressed

“Core” reinforced ceramic (Metal, zirconium, lithium disilicate, alumina oxide) Conventional cements (Zinc phosphate, polycarboxylate, Glass ionomer) No etch Adhesive cements (Resin-ionomers, self-adhesive resin cements)

“Core” reinforced ceramic (Metal, zirconium, lithium disilicate, alumina oxide) No etch adhesive cements Resin Modified glass ionomers (FujiCem, FujiPlus, RelyX Luting) Self-adhesive resin cements (Unicem, MaxCem, Multilink Automix, Panavia FL)

“Self-adhesive” resin cements (the benefits of resin without the technique sensitivity) Single component Self-Adhesive (Unicem, MaxCem, others) Assisted Self-adhesive resin cements (Multilink Automix, Panavia FL)

“Single Component Self-adhesive “ cements Unicem (3M) MaxCem Elite (Kerr) Embrace Wetbond ( Pulpdent) G-Cem (GC) BisCem (Bisco) Embrace

“Single Component Self-adhesive “ cements BisCem (Bisco) Embrace

“Single Component Self-adhesive “ cements Bond strengths (Reality) Dentin Enamel MaxCem 3.8 8.8 Embrace Unicem 7.7 16.6 BisCem 9.0 15.0 “Total-etch” 30.3 25.4 Relyx

Good physical properties Some adhesive properties Advantages of “Single Component self-adhesive” cements Good physical properties Some adhesive properties Very, very easy to use

Mediocre bonds to dentin and enamel Disadvantages of “Single Component self-adhesive” cements Mediocre bonds to dentin and enamel Questionable long term enamel bonds Questionable bonds to restorative substrate

Assisted “Self-etch” resin cements Panavia FL2.0 (Kuraray) Bistite II DC (J. Morita) Multilink Automix (Ivoclar)

Good physical properties Advantages of Assisted “Self-adhesive” cements Good physical properties Good adhesive properties Easier to use than “Total-etch” cements

Assisted “Self adhesive” cements Bond strengths (Reality) Dentin Enamel Panavia F 2.0 7.6 11.5 Embrace Bistite II 14.7 12.7 Multilink 15.1 16.4 “Total-etch” 30.3 25.4 Relyx

Involves an adhesive step Disadvantages of Assisted “Self-adhesive” cements Involves an adhesive step Bonds not as strong as “Total-etch”

Can we “etch “with phosphoric acid with self-etch cements? Enamel Bonds Total-etch Self-etch Panavia F 2.0 18.3 11.8 Unicem 16.6 8.5 Multilink 21.2 16.4 BisCem 15.0 13.8 Decreased bond strengths to dentin

When do I use what? Non-core supported ceramic: Core-supported Ceramic “Total etch” Core-supported Ceramic Minimal retention and resistance form? “Total-etch” with dual cure resin cement Adequate retention and resistance? “self-adhesive” resin cements

Hornbrook 2009 Updates – Full Day Events Topics include: 2009 Materials Update My top 10 failures and how YOU can avoid them! Treatment Planning the Full Mouth Rehabilitation Winning Case Presentation Techniques for a Tough Economy Prepless Veneers: Necessary Addition to Your Restorative Arsenal And much more! November 6th – Albuquerque, NM November 13th – Boston, MA at Tufts University