7Bonding to CeramicMacromechanical- no sharp edges or surfaces (promotes cracks). Create retentive preparations rather than alter the inside of the restoration.Micromechanical- acid etching and sand blasting. Acid etching with HydroFluoric acid works well for silica based materials because it will etch glass. Phosphoric acid does nothing to any surfaces except enamel and dentin. However, acid etching won’t touch alumina oxide and zirconia cores and may cause cracking. Sandblasting works best for both.Chemical- only with silane and only if silica is present. Use HF to etch silica-based ceramics.
8Cement TypesLuting cements- cements that achieve retention by filling in the gaps between the tooth and the restoration. Adhesion is at best a surface phenomenon of wetting and micro-mechanical interlocking.Bonding cements- stronger than luting cements so “gap filling” offers greater retention. Bonding to tooth structure through the smear layer or into dentinal tubules is more than just a surface phenomenon. Bonding to restorations can be achieved through the use of primers which allow for the chemical adhesion to inorganic fillers, or metal oxides.
9Luting Cements Used almost exclusively with metal based restorations. Self curing, with generally two components (liquid/powder or paste/paste) for mixing.Four classes: zinc phosphate; polycarboxylate; conventional glass ionomer; resin-modified glass ionomer (marginal Fl release).Of these classes, only conventional glass ionomer and RMGI cements have true indications in modern dentistry. Their indications are limited to metal; metal-based; or core strengthened, glass-free ceramic restorations with retentive preparations. Examples: FujiCem, RelyX Luting, Ketac Cem
10Luting Cements Paste/paste system Easy mixing, radiopaque, 3min. working timeLow film thickness (10 microns ).Do not use a dentin conditioner (removes smear layer).Fluoride release, low solubility
11Bonding CementComposite resin cements: are modified composite resin materials with high adhesion, low solubility, and good esthetics.Like any direct composite materials, this class of cements must be used with a bonding system. There are Three subtypes: total-etch system, self-etching system, self-adhesive systems.
12Composite Resin Cements Total-etch system- most systems are dual cured or light cured. The steps are as similar and diverse as that for direct composite restorations. Examples: Variolink II, Calibra, Duolink, RelyX Veneer cement. In general, any of these systems are moisture intolerant.Self-etching systems- Typically a dual cured, two part system where the acid etching and bonding steps are replaced with a self-etching primer mixed and activated with a bonding agent. The manufacturer’s instructions usually require PhD in interpretive science to decipher. Examples: Panavia F
13Composite Resin Cements Self-adhesive cements- 3M-RelyX UniCem is the #1 selling cement in the US market. It is a capsule dispensed dual cured cement that eliminates separate etching and bonding steps. It is uniquely moisture tolerant, and has a low risk of post- operative sensitivity. It has a broad range of applications and a simplified technique. Kerr MaxCem.Best for metal crowns.
15Choosing The Right Cement The determination of the cement type begins with the clinical situation not vice versa. This is determined in the treatment planning stage.The key factors that determine restoration and cement type are: esthetic demands, ability to maintain a dry field, occlusal forces, remaining tooth structure, prep design (retentive or non-retentive), and margin location.In general, weak restorations must be adhesively bonded with strong cements.Ceramic restorations require either micro-etching or acid-etching of the undersurface and silane coating to achieve bonding with resin cements; this is not achievable with luting cements.
16Other Types of Cements PolyCarboxylate – Durelon (3M ESPE) Glass Ionomer -Ketac Cem (3M ESPE)Fuji I (GC America)RMGI -RelyX Luting and Luting Plus (3M ESPE)Fuji Cem and Fuji Cem 2 (GC America)
17Other Types of Cements Bonded Resin Cement - RelyX Unicem Aplicap * Dual Cure and Self-Adhesive – NOT for VeneersRelyX Unicem 2 Self-Adhesive (3M ESPE) *Claims no need for etching, priming or bonding of toothRelyX Veneer (3M ESPE)Light Cure only – all types of colors to choose fromVariolink Veneer (Ivoclar) *For Veneers, Inlays and OnlaysNX3 (Kerr)Light-cure and Dual-cure available in 5 shadesMaxCem Elite (Kerr)Single Step for all restorationsMultiLink (Ivoclar)Calibra (Dentsply)
19Temporary Cement Premier Implant Cement (Premier) Resin based design for security and able to retrieveIntegrity TempGrip (Dentsply)Zinc Oxide, Non-EugenolTempBond (Kerr)Clear version claims to have Triclosan (anti-bacterial to prevent gingivitis but may inhibit muscle contraction – FDA is checking on it)
20Desensitizers Gluma (Heraeus) MicroPrime (Danville) Comes in Liquid Bottle, Single Use and GelMicroPrime (Danville)Has the old B version and now G version that is comparable to Gluma at a much lower pricePrestige Dental has it for $50.95 / Gluma is $ in the Benco Catalog
21Differences Between Self and Total Etch Enamel acid-etching involves demineralizing portions of hydroxyapatite crystals to develop a porous surface for micro-mechanical bonding. Today, acid-etching is performed on dentin, and with a total-etch (TE) or self-etch (SE) technique.Total Etch - In the TE technique, the outer layer of dentin is decalcified, removing the smear layer and opening the underlying dentin tubules. This exposes collagen fibers that are then infiltrated with a primer, followed by the application of a resin adhesive. Primer and adhesive are applied simultaneously in many systems. In this procedure, it is critical that you completely seal dentin tubules to avoid bacterial invasion and/or sensitivity. Generally this technique is used for larger direct restorations and indirect restorations.Self Etch - Rather than removing the smear layer, the SE approach involves the application of an acidic primer that will promote micro-mechanical bonding of the adhesive to the smear layer and the underlying dentin. This technique minimizes the potential for postoperative sensitivity by preventing the collapse of the collagen fibers that can occur after conditioning and drying in the TE process. The SE technique has less clinical history, but appears to be best in less invasive procedures such as shallow Class I or Class II restorations.
22Primers and Bonding OptiBond (Kerr) – Total-etch XP Bond (Dentsply) – Universal Total-etch “(1 bottle/1 coat)”ScotchBond Universal (3M ESPE) – Total or Self-etchClaims to bond to metal and Zirconia surfacesAdper Single Bond Plus (3M ESPE) – Total EtchiBond (Heraeus) – Has both Total and Self-etch productsClaims to Desensitize as well with the Self-EtchPeak Universal (Ultradent) – Works with both Self and Total-etch techniques,Also contains Chlorhexidine for added bond longevity and strengthBondForce (Tokuyama) – Self-etching, Fluoride releasingClearfil SE (Kurary) * - Self-etching primer and bonding agentClearfil S3 (Kurary) – Self-etch, one-step, fluoride releasingAll-Bond ACE SE – Self EtchBrush N’ Bond (Parkell) – Self-etching but seems to be more of a sealer
23Universal CompositeEstelite Omega (Tokuyama) – Spherically filled supra-nano (82% filler)Estelite Sigma Quick (Tokuyama) –“Radical Amplified Photopolymerization Technology”Filtek Supreme Ultra (3M ESPE) * - Nanotech provides retention of a microfill and the strength of a modern hybridGrandioSO (Voco)Vit-L-Escence (Ultradent)Tetric Evoceram (Ivoclar)Heliomolar (Ivoclar)Venus Diamond (Heraeus)Esthet-X HD (Dentsply)N’Durance (Septodont)Premise (Kerr)Herculite Ultra (Kerr)SonicFill (Kerr) – $ on average for handpiece / Up to 5 mm then cure
24Flowable Composite Filtek Supreme (3M ESPE) Also Filtek Bulk Fill – Cure up to 4 mmStarflow (Danville) – Claims to have highest compressive strengthSurefill SDR (Dentsply) * - Up to 4 mm, 15 of .25 g. for $70-80 (3.75 g.)Venus Bulk (Heraeus)- Up to 4 mmHyperFIL (Parkell) – 22 g. for $65.25, Doesn’t work well with self-etch. Claim to need Brush N’ Bond.Tetric EvoCeram Bulk Fill (Ivoclar)Contains Ivocerin – Patented light activator to help full light curing
26Crown and Bridge Temp Materials Integrity (Dentsply) *ProTemp Plus (3M ESPE)Structur 2 (Voco) * - Appears to be best priceLuxatemp (DMG America) – Star, Plus and SolarPerfecTemp II (DenMat)ExactaTemp (Exacta)MaxiTemp (Henry Schein)
28Alginate Identic (Dux) – Jeltrate (Dentsply) Kromaphase Dust free or Regular Powder (Color change from purple to mix, pink to load and white to seat then 30 sec.)Jeltrate (Dentsply)Chromaclone (Ultradent) * – Walterberry and Bubble gum Flavors, Same color changes as KromaphaseCOEflex (GC America)
29Bite Registration Blu-Bite HP or Clear (Henry Schein) Blu-Mousse (Parkell) *30 sec. working and 30 sec. set timeSuperDent (Darby Dental)Genie (Sultan)Superfast has 60 sec. setting time in Mint flavorMegaBite (DenMat)Spearmint flavor – 55 sec. set timeVanilla Bite and Chocolate Bite (DenMat – just bought from Philips Discus)What else to say, its chocolate flavored!!! Claims 45 set time.
30Vinyl Polysiloxane Aquasil Ultra (Dentsply) * Has XLV, LV, Monophase, Heavy and Rigid OptionsExafast NDS (GC America) *Regular, Monophase and Heavy Options90 sec. set even in a wet enviornmentGenie (Sultan) *Berry flavored with Extra Light, Light, Regular and Heavy BodyImprint II Garant (3M ESPE)Precision Plus (Burkhart)FlexiTime (Heraeus)Has an Advanced ThermaSense (ATS) which allows fast setting material with flexible working times.
31PolyEther Impregum F (3M ESPE) Impregum Soft Base/Catalyst Mix Cartridge mix from tip, Easier removal
33Take Home Bleaching Venus White Pro (Heraeus) 16% - Daytime of 4-6 hours, Nightime 8-10 hours22% - Daytime of 60 minutes 1-2 times a dayOpalescence PF (Ultradent) – Melon, Mint, Regular10% hours or overnight15% hours20% hours35% - 30 minutesOpalescence Oh! (Ultradent)Same as PF but in individual dosesZoom NightWhite and Day White (Philips)NightWhite 10%, 16% and 22% are Hydrogen Peroxide 4%, 6%, 8% respectivelyDayWhite is 9.5% and 14% (The 14% was named 38% but they changed the name to not have people thinking it was a full 38% HP. It is a mix of HP and Carbamide)
34In-Office Bleaching Opalescence Boost 40% (Ultradent) 2 – 20 minute applicationsClaims to strengthen enamel, decrease sensitivity and prevent cariesPatient kit - $51.99Venus White Max 38% (Heraeus)3-4 – 15 minute applicationsContains potassium nitrate to decrease sensitivityPatient kit - $55.99Pola Office 37.5% (SDI North America)3 – 8 minute applicationsNo mixing materials, Contains potassium nitrate, with or without lightPatient kit - $75.99LumaWhite Plus 35% (Luma-lite)Includes “Stay Bright” professional take-home maintenance kit/enhancerPatient kit - $68.99
35In-Office Bleaching Zoom WhiteSpeed BriteSmile Dash Clinicals show proven 8 shades brighter in 45 minutesUses LED light to accelerate the bleaching gelBriteSmileSimilar to WhiteSpeedIn concentrations of 15 or 25% Hydrogen PeroxideDash30% hydrogen peroxide whitening gel. No syringe-to-syringe mixingSensitivity management. Includes a syringe of Relief ACP, that combines chemical sensitivity relief (potassium nitrate) and long-term relief with ACP (Amorphous Calcium Phosphate) and fluoride.These are all Philips brands. They also have a Zoom Whitening Pen for maintenance with 5.25% Hydrogen Peroxide.
36Final Wrap-Up Sample Requests Treatment Videos Discounts/Rebates How to for Cutting/Temping/Bonding VeneersPossibility of Starting CE LibraryDiscounts/Rebates