Cements Luting materials from Ivoclar Vivadent

Why Use Cement Cements are used in dentistry to join the restoration to the tooth structure (dentition) when a higher strength repair is needed in place of using a composite material. The three main cement categories are: Adhesive Self-adhesive Conventional

Terminology The terms cementing, luting and bonding are used interchangeably within the industry. Cementing is a generic term for joining two materials together. Luting means no adhesive interaction between the surfaces. The retentive form of the tooth (prep) and the crown allow the materials to “interlock” together using the cement as a filler between the two. Bonding means the true adhesion between the two joining materials.

Terminology Retentive – the ability to hold two things firmly together when they will not adhere (stick) to each other. Retentive Prep Preparation with parallel walls (taper less than 10) and minimum height (4 mm). Non-retentive Prep When there isn’t enough tooth structure remaining to account for maximum taper or minimum height.

Terminology Adhesive Luting-Composite Systems Create adhesion between the restoration and the tooth structure. Advantages Highest bond strength when adequate retention is not possible. Better marginal seal Disadvantages Most number of steps Most expensive Two types of adhesive luting-composite systems Total Etch Self Etch

Terminology Self Adhesive Resin Cements Self-adhesive resin cements combine an easy conventional cementation technique, with the advantages of adhesive luting-composite systems. Advantages Increased strength vs. conventional cement, but less than adhesive luting-composite systems Less steps than adhesive cementation No adhesives required Disadvantages - Must have a retentive prep Must use high-strength restoration with adequate thickness and tight fit

Terminology Conventional Cements Conventional cements are referred to as “luting agents” since there is no chemical adhesion between surfaces. Advantages Most affordable Least number of steps Fluoride Release Disadvantages Must have a retentive prep and high strength material Lowest to no bond strength

Terminology Light Cure Self Cure with Optional Light Cure Dual Cure The cement must be polymerized with a curing light Self Cure with Optional Light Cure The cement can be left to polymerize on its own without a curing light or polymerization can be expedited by using a curing light. Dual Cure The cement will start to set but polymerization with a curing light is a must to completely cure.

When To Use What Type of Cements Adhesive Situation Non-retentive prep Weaker restorative material (IPS Empress) Adhesive cementation can be used with high strength materials (IPS e.max) to get the strongest combination of strength and esthetics. Self Adhesive Situation Retentive prep High strength restorative material Conventional Cement

How to Use Cement Adhesive luting composite systems High Level Bond Enamel Adhesive luting composite system Restoration Adhesive Primer Dentin High Level Bond Self-adhesive resin cements Enamel Self-adhesive resin cement Lithium disilcate glass ceramic Base metal alloys Oxide ceramics [ZrO2, Al2O3] Noble metal alloys Primer Dentin Lower Level Bond Conventional cements Enamel Conventional Cement Restoration Dentin Lowest Level Bond

Cement Category Differences * Highest bond strength * Highest fracture toughness * No retentive prep * Most # of steps Adhesive Self Adhesive Convention Total Etch Variolink II Variolink Veneer Self Etch Multilink Automix * Moderate bond strength * Moderate fracture roughness * Retentive prep * Moderate # of steps NO IV cement sold in North America SpeedCEM * Lowest bond strength * Lowest fracture toughness * Retentive prep * Least # of steps

Competitors Adhesive Self Adhesive Conventional * RelyX Ultimate * NX3 * Calibra * Panavia * BiFix QM * Clearfil Esthetic Cement EX * Insure * Duo-Link * RelyX Unicem 2 * RelyX Unicem * MaxCEM Elite * BiFix SE * BisCem * G-Cem * Breeze * Infinity * iCem * All Fuji Products * RelyX Luting Plus * Ceramir * Ketac Adhesive Self Adhesive Conventional The largest competitor to Ivoclar Vivadent cements is 3M’s RelyX Ultimate (Multilink Automix), 3M RelyX Unicem 2 (Multilink Automix and SpeedCEM) and Kerr’s NX3 (Multilink Automix).

Surface Treatment of Restorative Materials Cleaning & Silanating All-Ceramic Restorations

Ivoclean Universal cleaning paste effectively cleans the bonding surfaces of prosthetic restorations after intraoral try-in. Creates optimum pre-requisites for the adhesive luting procedure. * Phosphoric Acid should never be used to clean Metal or Zirconia restorations. There are several different ways dentists can clean out a restoration after it’s been tried in the mouth ie water, phosphoric acid, alcohol, steam cleaner, ultrasound machine. They are all options but they yield different results. The most effective way to completely remove ALL of the contaminants off the surface of the restoration and prepare it for ADHESIVE or SELF-ADHESIVE cementation is to use Ivoclean.

Ivoclean® Universal Restorative Cleaning Agent Simple Application Rinse & dry restoration after try-in Apply Ivoclean to restoration and allow to react for 20 seconds. Rinse & dry

+ Monobond® Plus One primer for all materials In the past … different primers for different materials were required. Now … one primer can be used for all the different restorative materials. + Glass-Ceramics Oxide Ceramics Metal-Ceramics Metal

Monobond® Plus One primer for all materials Simple Application Apply Monobond Plus to restoration and allow to react for 60 seconds Air dry

Ivoclean/Monobond Plus Competition Main Competitor’s Ivoclean- Phosphoric Acid Monobond Plus- Scotchbond Universal Ivoclean’s Main Competitive Advantage Only universal cleaning agent Monobond Plus Main Competitive Advantage Used specifically on all types of restorative materials for superior performance compared to an all in one system (tooth and restorative primer) which yields limited performance. SpeedCEM maintains a consistent bond strength when stored properly (refrigeration) for the full 2 years of its shelf life even after you remove it from the clear plastic package. - Unicem 2- once taken out of the silver package, has a shelf life of only 6 months. This is stated in their own IFU’s:                     Storage and Stability Store RelyX Unicem 2 Automix in the pouch at 15°-25 °C/59°-77 °F. After removal from the pouch, use the product within 6 months and before the lapse of the expiration date. Constantly high humidity accelerates the setting and must be avoided. - This is a big deal especially at a university where they may open several syringes and let them sit there over time. We have also found in our own applied testing center that when using an “older” syringe of Unicem 2 the bond strengths to drop. A freshly opened syringe is around 15 MPa but an older one is around 8-10. On the syringe there is a place to write down the date when you open the silver package- that’s saying something!

Variolink® II Esthetic Adhesive Resin Cement For more than 25 years, this product has clinically proven itself in more than 20 million restorations worldwide. Dual Cure Excellent clinical long-term results. Based on Total Etch adhesive technology for higher bond strengths to Enamel (e.g. veneers, inlays/onlays) Available in 6 shades in 4 degrees of translucency and 2 consistencies:

Variolink® II Esthetic Adhesive Resin Cement Application Etch tooth with phosphoric acid. (15s on dentin/30s on enamel). Rinse and dry leaving surface moist. Apply Excite F DSC to to moist preparation and agitate for 10 seconds. Air dry. Mix base and catalyst cement and load cement into pre-treated restoration & seat Remove excess Light-cure

Variolink® II Esthetic Adhesive Resin Cement Main Competitors Calibra Clearfil Esthetic Cement EX Insure Variolink II Main Competitive Advantage Higher radiopacity Longer working time

Variolink® Veneer Adhesive Resin Cement Total Etch system Light-cure only. Amine-free for optimal shade stability. Available in 7 "Value shades" designed specifically for highly esthetic veneers. Matched Try-In shades Fast, easy clean-up Indicated for Veneers, inlays and onlays with a low thickness (< 2.0 mm) and a high degree of translucency.

Variolink® Veneer Adhesive Resin Cement Application Apply phosphoric acid to tooth (15s on dentin/30s on enamel). Rinse and dry leaving surface moist. Apply Excite F (bonding agent) to moist preparation and agitate for 10 seconds. Disperse to a thin layer and light cure for 10 seconds. Load cement into pre-treated restoration & seat Remove excess Light-cure

Variolink® Veneer Adhesive Resin Cement Main Competitors RelyX Veneer Variolink Veneer Main Competitive Advantage One less step Additional adhesive not required

Multilink® Automix Universal Adhesive Resin Cement High-immediate bond strengths to ALL types of restorative materials. Easy clean-up. Self-etching, self-curing primer for reduced sensitivity. Self-cure with optional light-cure High-level radiopacity Room temperature storage Available in 4 shades

Multilink® Automix Universal Adhesive Resin Cement Simple Application Coat prep with self-etching primer. Then scrub primer into preparation for 30 seconds starting with enamel and working toward dentin Air dry Load cement into pre-treated restoration & seat Remove excess Light-cure or self-cure

Multilink Automix Competition Main Competitors 3M’s RelyX Ultimate Kerr’s NX3 Multilink’s Main Competitive Advantage Easier Clean-up Long term/PROVEN clinical success Over 10 million restorations placed since 2004 99% survival rate Proven combination with IPS e.max SpeedCEM maintains a consistent bond strength when stored properly (refrigeration) for the full 2 years of its shelf life even after you remove it from the clear plastic package. - Unicem 2- once taken out of the silver package, has a shelf life of only 6 months. This is stated in their own IFU’s:                     Storage and Stability Store RelyX Unicem 2 Automix in the pouch at 15°-25 °C/59°-77 °F. After removal from the pouch, use the product within 6 months and before the lapse of the expiration date. Constantly high humidity accelerates the setting and must be avoided. - This is a big deal especially at a university where they may open several syringes and let them sit there over time. We have also found in our own applied testing center that when using an “older” syringe of Unicem 2 the bond strengths to drop. A freshly opened syringe is around 15 MPa but an older one is around 8-10. On the syringe there is a place to write down the date when you open the silver package- that’s saying something!

SpeedCEM® Self-Adhesive Resin Cement SpeedCEM features an integrated adhesion promoter (MDP- monomer), which creates a chemical bond to: dentin & enamel metals zirconium oxide Therefore, no separate adhesives or bonding agents are required. Available in 3 shades (transparent, yellow and opaque) MDP = 10-Methacryloyl- oxydecyl-Dihydrogen-Phosphates Self-adhesive systems combine the adhesive and the resin to minimize steps. This “dilutes” the efficiency of the adhesive resulting in lower bond strength. 29

SpeedCEM Competition Main Competitors RelyX Unicem 2 RelyX Unicem Maxcem Ceramir SpeedCEM’s Main Competitive Advantage Radiopacity Consistently high bond strength SpeedCEM maintains a consistent bond strength when stored properly (refrigeration) for the full 2 years of its shelf life even after you remove it from the clear plastic package. - Unicem 2- once taken out of the silver package, has a shelf life of only 6 months. This is stated in their own IFU’s:                     Storage and Stability Store RelyX Unicem 2 Automix in the pouch at 15°-25 °C/59°-77 °F. After removal from the pouch, use the product within 6 months and before the lapse of the expiration date. Constantly high humidity accelerates the setting and must be avoided. - This is a big deal especially at a university where they may open several syringes and let them sit there over time. We have also found in our own applied testing center that when using an “older” syringe of Unicem 2 the bond strengths to drop. A freshly opened syringe is around 15 MPa but an older one is around 8-10. On the syringe there is a place to write down the date when you open the silver package- that’s saying something!

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Cements Luting materials from Ivoclar Vivadent Thank you