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Advanced Cementation Update Webinar Clinical Mastery (www.clinicalmastery.com)  Over-the-shoulder Prepless veneer courses  Full mouth rehabilitation.

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Presentation on theme: "Advanced Cementation Update Webinar Clinical Mastery (www.clinicalmastery.com)  Over-the-shoulder Prepless veneer courses  Full mouth rehabilitation."— Presentation transcript:

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2 Advanced Cementation Update Webinar

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

4 Webinar October 14th John Nosti, DMD The Why, Where, & When of bite relationships The Why, Where, & When of bite relationships

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

7 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)  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)

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

9 “Tack & Wave” Cementation Veneers and anterior crowns

10 Emprethin evaluation

11 Be Careful!!! 0.2 mm glass is fragile!

12 OptraGate (Ivoclar)

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14 Hydrogen Peroxide in Ultradent Syringe

15 Metal strip removes any interproximal Luxatemp and freshens the enamel

16 Try in independently DRY

17 Occlude Spray Powder (Pascal)

18 Try-in collectively DRY!  Check complete seating  Proximal contacts  Check complete seating  Proximal contacts

19 Dry Erase Marker Mesial Surface

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21 Distal Surface Distal Surface

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24 Variolink Veneer (Ivoclar/Vivadent)  Value based  0  +1, +2, +3  -1, -2, -3  Microfill  Value based  0  +1, +2, +3  -1, -2, -3  Microfill

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27 0 0 +2

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30 Clean and acidify with 35% Phosphoric acid

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

32 Place bonding agent (All Bond 3) inside dry restoration

33 Load restoration with resin cement

34 Vivapad (Ivoclar)

35 Etch with 35% phosphoric acid for 15 seconds per tooth

36 Apply Systemp desensitizer for 15 seconds

37 Effect of Remoistening 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 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 Product Dentinal Bond Water vs. Desensitizer/Rewetting Agent

38 “suction” away excess; do not desiccate

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

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41 Adec Warm Air Tooth Dryer

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

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

44 H old light guide 1 inch from restorations and light cure 3-5 seconds on facial and lingual H old light guide 1 inch from restorations and light cure 3-5 seconds on facial and lingual

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

46 “ Pick" away excess using Bard Parker or scaler

47 Floss through contacts using a Brasseler Serrated Saw

48 Floss through contacts using waxed dental floss

49 Place DeOx (Ultradent) on all margins

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

51 Curing Lights  Photoinitiators  Camphoroquinone nm  PhenylDipropandione- 430 nm  Photoinitiators  Camphoroquinone nm  PhenylDipropandione- 430 nm

52 CQ 488 nm PDP 430 nm Wavelength (nm)

53 OptiLux 501 (Demetron) OptiLux 501 (Demetron) Emits light with wavelength nm

54 CQ 488 nm PDP 430 nm Wavelength (nm)

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

56 CQ 468 nm PDP 430 nm Wavelength (nm)

57 BluePhase G2 (Ivoclar) BluePhase G2 (Ivoclar) Emits light with wavelength nm

58 Fusion

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

60 Run Serrated Saw through contacts

61 1954N Strip (3M)

62 Epitex Strips (GC)

63 15 micron finishing diamond (Brasseler))

64 15 micron football-shaped diamond on lingual

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66 OptraFine Porcelain polishing system (Ivoclar)

67 DiaShine ( V & H )

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72 Solid Model Contacts

73 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

74 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

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78 Blot Dry dentin

79 Apply primer

80 Air dry primer

81 Light polymerize for 10 seconds

82 Posterior RelyX ARC (3M) Posterior RelyX ARC (3M)

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84 Hold passively for 3 minutes

85 Remove excess with scaler or explorer Remove excess with scaler or explorer

86 Floss through contacts

87 Cover margins with oxygen-inhibiting medium Cover margins with oxygen-inhibiting medium

88 Light polymerize for at least 60 seconds Light polymerize for at least 60 seconds

89 Use scaler and/or #12 Bard Parker Use scaler and/or #12 Bard Parker

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

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

95 e.Max Pressed Lithium disilicate pressed

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

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

98 “ Self-adhesive” resin cements (the benefits of resin without the technique sensitivity) “ 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)

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

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

101 “Single Component Self-adhesive “ cements Embrace Bond strengths (Reality) DentinEnamel MaxCem Unicem BisCem “Total-etch” Relyx

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

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

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

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

106 Assisted “Self adhesive” cements Embrace Bond strengths (Reality) DentinEnamel Panavia F Bistite II Multilink “Total-etch” Relyx

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

108 Can we “etch “with phosphoric acid with self-etch cements? Decreased bond strengths to dentin Total-etchSelf-etch Panavia F Unicem Multilink BisCem Enamel Bonds

109 When do I use what?  Non-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  Non-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

110 Hornbrook 2009 Updates – Full Day Events November 6 th – Albuquerque, NM November 13 th – Boston, MA at Tufts University 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!


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