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1
CEMENTS IN
ORTHODONTICS
By
Sonal Sahasrabudhe
1st year PG
2
CONTENTS
Introduction
History
Classification Of Cements
Ideal Requirements Of Cements
Zinc Phosphate Cement
Zinc Polycarboxylate Cement
Zinc Silicate Cement
Zinc Silico-phosphate Cement
Glass Ionomer Cements
Recent Advances
Conclusion
Bibliography
3
INTRODUCTION
Cement: substance that hardens to act as a base, liner,
filling material, or adhesive to bond devices and prostheses
to tooth structure or to each other (Phillips)
4
For this reason physical characteristics of dental cement and
their manipulation are of particular interest to orthodontists
6
(1968) Smith introduced zinc polycarboxylate cement
7
Classification
Cements
Zinc GIC
Zinc Zinc sillico
Polycarboxylate
Phosphate Phosphate
Filled Unfilled
8
4 Principal types of cements of
acid-base reaction
Zinc Zinc
Phosphate Polycorboxylate
Zinc Oxide
Aq. Polyacrylic
Phosphoric acid
acid Fluorine
containing
alumino
-silicate
glass
Glass
Silicate Ionomer
9
USES OF DENTAL CEMENTS
CEMENT PRINCIPAL USES SECONDARY USES
11
ZINC PHOSPHATE
12
COMPOSITION
Powder % Use
Zinc oxide 90 Principle ingredient
Mg oxide 8.2 Improvement in
mech proprties,
colour stability
Silicon dioxide 1.4 Inactive filler,
provides colour
Bismuth trioxide 0.1 Smoothness to
freshly mixed
cement, increses
setting time
Oxides of Ca Ba, 0.1 Radio-opacity
sulfate of Ba
Copper oxide, Traces Colour Pigments
manganese dioxide,
platinum, bismuth
oxide, Iron oxide or
titanium
13
LIQUID
Liquid % Use
Phosphoric acid 55
Free 38.2 Reacts with zinc
Combined (Al, Zn) 16.2 oxide
Buffer, reduces
rate of reaction
Water 36 Controls rate of acid-
base reaction
Manufacturing:
The ingredients of the powder are sintered at temperatures between
1000oc to 1400oc into a cake that is ground into fine powders.
14
CHEMISTRY
Powder+
Liquid= Acid
attacks surface
of powder
particles
Release of
zinc and Al
in liquid
Al first forms
complex with
phosphoric acid and
reacts with Zinc=
Zinc
aluminophosphate
gel
Set cement= core
structure primarily of
unreacted Zinc
embedded in cohesive
amorphous matrix of
zinc aluminophosphate
15
MANIPULATION
Proportioning and consistency of the powder & liquid vary
to some degree with the clinical situation. The maximal
amount of powder be used to ensure minimum solubility
and maximum strength.
MIXING
Incorporate small quantity of powder with brisk spatulation.
A considerable area of the mixing slab should be used.
A good rule to follow is to spatulate each increment for 15
seconds before adding another increment.
Mixing time:-approximately 1 minute and 30 seconds. The
recommended P:L ratio -1.4g to 0.5 ml
16
ZINC PHOSPHATE MIXING
17
Precautions while banding
The band should be seated immediately, if possible before
matrix formation occurs
After placement hold under pressure until the cement sets
to minimize the air space
Dry field of operation
Removal of excessive cement
It is recommended that a layer of varnish or other non
permeable coating should be applied to the margins.
This allows the cement more time to mature & develop an
increased resistance to dissolution in oral fluid.
WORKING TIME AND SETTING TIME
Defined as the elapsed time from the start of mixing until the
point of the needle no longest penetrates the cement as the
needle is lowered onto the surface.
20
RETENTION
Setting of the zinc phosphate cement does not involve any
reaction with surrounding hard tissue or other restorative
materials. Therefore, primary bonding occurs by
mechanical interlocking at interfaces and not by chemical
interaction.
BIOLOGIC PROPERTIES
The presence of the phosphoric acid, the acidity of the
cement is quite high at the time when a band is placed on a
prepared tooth.
pH after 2 minutes of mixing, is approximately 2.
About 5.5 at 24 hours
21
FACTORS GOVERNING THE RATE OF SET OF ZINC PHOSPHATE CEMENT
Controlled by manufacturer
A) Powder composition
B) Degree of powder calcination
C) Particle size of the powder
D) Water content of liquid
E) Neutralization of liquid
Controlled by operator
A) Powder/ liquid ratio
B) Rate of powder incorporation
C) Mixing temperature
D) Manner of spatulation
E) Water contamination or loss from fluid.
22
Advantages and
Disadvantages
Can be mixed easily
Set sharply to a relatively strong mass from a fluid
consistency
Bond strength adequate for clinical service
Manipulation less critical compared to other cements
23
ZINC POLYCARBOXLATE CEMENT
24
COMPOSITION AND CHEMISTRY
Powder % Use
Zinc oxide 90 Principle ingredient
Mg oxide/ Stannic Up to 10% Improvement in
oxide mech properties,
colour stability
Silicon dioxide 1.4 Inactive filler,
provides colour
Bismuth trioxide/ 0.1 Smoothness to
Aluminium oxide freshly mixed
cement, increases
setting time
Stannous fluoride 4-5%
Pigments
Liquid % Use
Polyacrylic acid 40
Copolymers of
25
Itaconic and maleic
SETTING REACTION
Interaction of
Acid base reaction acid and
powder
particles
Release of zinc,
Mg and
ionization of
polycarboxylic
acid
26
BONDING TO TOOTH STRUCTURE
27
WORKING AND SETTING TIME
28
MIXING
P/L Ratio:- 1.5 parts of powder, to 1 part of liquid by
weight.
A glass slab /paper pad supplied by manufacturers
Dispense liquid just before mixing.
The power is rapidly incorporated into the liquid in large
quantities.
Mixing Time:- Usually with in 30 sec. (Increased by frozen
slab method)
Note
For good bonding the cement must be placed before it loses its
glossy appearance which indicates free carboxylic acid groups
on the surface of the mixture that are vital for bonding to tooth
structure.
29
SURFACE PREPARATION
The surface of the metal is abraded with a small stone
or sand blasted with high pressure air to improve
wettability and mechanical bond at cement metal
interface.
Apply 10% Polyacrylic acid solution for 10 to 15 seconds
followed by rinsing with water, for removal of smear
layer before placement.
After cleansing, the tooth is isolated to prevent further
contamination by oral fluids. Blotting the surface before
cementation is considered sufficient drying procedure.
30
REMOVAL OF EXCESS
POLYCARBOXLATE CEMENT
During setting the cement is rubbery and makes the
removal of the excess quite difficult.
31
Factors influencing setting time
P/L ratio
Powder composition
Type of powder
32
POLYCARBOXYLATE AFTER 30 SEC
AND 1 MINUTE
33
GENERAL PROPERTIES
Film Thickness
More viscous than zinc phosphate cement.
34
MECHANICAL PROPERTIES
1) STRENGTH
Compressive strength is inferior to zinc phosphate
cement in this respect. However, the tensile strength is
slightly higher.
It is not as stiff as zinc phosphate cement. Its modulus
of elasticity is less than half that of zinc phosphate.
It is not brittle as zinc phosphate cement. So difficult to
remove after set.
2) SOLUBILITY
The solubility of cement in water is low, but when it is
exposed to organic acids with a pH 4.5 or less, the
solubility markedly increases.
Also, reduction in P:L ratio results in significantly higher
solubility and disintegration rate in oral cavity
35
3) RETENETION
Despite the adhesion to tooth structure, polycarboxylate
cements are not superior to zinc phosphate cement in
the retention of band or bracket.
36
BIOLOGIC CONSIDERATION
37
ZINC SILICATE CEMENT
38
COMPOSITION
POWDER LIQUID
Silica Phosphoric acid 50%
Zinc oxide Zinc salts 4-9%
Magnesium oxide Aluminum salts
Fluoride 13.25%
39
Mixing Time: 1 min
Semi-transulcency
DISADVANTAGES
1) Rheological property is poor of the cement leading to
higher film thickness.
41
ZINC SILICOPHOSPHATE CEMENT
42
Properties
Mixture of silicate glass, a small percentage of zinc oxide powder
and phosphoric acid.
Strength is somewhat superior to that of zinc phosphate
cement,
Appears somewhat translucent and releases fluoride by virtue of
silicate glass.
Less soluble in the mouth than zinc phosphate cement
The fluoride content should give some anticariogenic action.
Therefore it is recommended for patients with high caries rate.
Flow property of the mix is not as good as zinc phosphate
cement, leading to higher film thickness
Does not bond to tooth structure; hence retention is by
mechanical interlocking
Esthetically it is superior to zinc phosphate cement
43
Advantages
Better bond strength and toughness than zinc phosphate
cement
Shows considerable fluoride release hence anticariogenic so less
incidence of decalcification under the bands
Translucent( better esthetics than zinc phosphate)
Under clinical conditions lower solubility
Disadvantages
Higher film thickness
Greater pulpal irritation
In both the laboratory and clinical studies it was found that it
remained attached to the enamel in higher percentages after a
band had become loose. It also was found that the remaining
cement was often quite difficult to remove from the enamel.
44
GLASS IONOMER
CEMENT :
Generic name of a group of materials that use silicate
glass powder and as aqueous solution of polyacrylic acid
This materials acquires its name from its formulation of a
glass powder and an ionomeric acid that contains carboxyl
groups.
Polyalkenoate cement or ASPA
Water based cement
ADA specification No. 96
45
History
1965 A.D Wilson mixed dental silicate glass powder &
aqueous solutions of various organic acids including poly
acrylic acid. Set cement was sluggish. Not reported or
published.
47
Classification of GIC
Classification 1
Based on 3 types of GICs adopted by Wilson and Mclean
(1988)
Type I for luting cement (Orthodontic purpose)
Type II restorative material.
a) Aesthetic
b) Reinforced GIC
Type III use as liner or base.
NOTE
Luting cement for orthodontic appliances, bands, brackets is
similar to the standard luting cements, but the setting time has
been extended to allow a generous working time
Classification 2
The general use-based classification of GICs is as follows:
1) Conventional GIC
52
Powder
Component Type Use
Al2O3 & SiO2 glass Main Matrix formation
component
53
COMPOSITIION OF TWO GLASS IONOMER
CEMENT POWDERS
54
LIQUID
Content % Use
Polyacrylic acid 45 % Main reacting acid
Increases viscosity
Water 50% Medium for
reaction
Hydration of matrix
Copolymers like Increase reactivity
Itaconic acid, of liquid
Maleic acid, Decrease viscosity
Tricarboxylic acid Reduce gelation
tendency
Increase shelf life
Tartaric acid Improves handling
5-10 characteristics,
Powder strength
To increase working time: Increases working
Glass powder
Anhydrous/ Water settable GIC timepolyacid powder
Freeze dried
Eg. Ketac-Cem, ESPE
Shortens setting
Liquid
time 55
Water OR water + tartaric acid
CHEMISTRY OF SETTING
Acid base reaction
Acid: Poly (alkenoic acid) Base: Fluoroaluminosilicate
glass with high F content
alcium, aluminum, sodium, and fluorine ions are leached in to the aqueous mediu
e polyacrylic acid chains are cross-linked by the calcium ions and form a solid ma
(Next 24 hours)
new phase forms in which aluminum ions become bound with in the cement mi
This leads to more rigid set cement
Some of the sodium ions may combine with fluorine ions forming
sodium fluoride uniformly dispersed within the set cement.
56
3 Phases of setting of GIC
1. Ion Leaching Phase( Immediately after mixing)- Placement of
band should be done before the end of this phase
Appearance- shiny/ glossy
2. Hydrogel Phase( initial set, 5-10 min after mixing)-cement
should be protected from moisture and desiccation
Appearance- Rigid, opaque
3. Polysalt gel phase( final set)- can continue for several months
Appearance- reduced opacity
57
The cement consists of an agglomeration of unreacted
powder particles surrounded by a silica gel in an
amorphous matrix of hydrated calcium and aluminum
polysalts.
58
ROLE OF WATER IN THE SETTING
PROCESS
1)Reaction medium initially
2)Hydration of cross-linked matrix, thereby increasing the
strength
During the initial reaction period, this water can readily be
removed by desiccation and is called loosely-bound water.
As setting continues, the same water hydrates the matrix
and cannot be removed by desiccation and is called
tightly-bound water.
59
PROPERTIES OF GLASS IONOMER
CEMENT PHYSICAL PROPERTIES
The initial solubility is associated with leaching of
intermediate products or those not involved in
matrix formation.
60
Physical Properties
1. Low solubility
2. Coefficient of thermal expansion similar to dentin
3. Fluoride release and fluoride recharge
4. High compressive strengths
5. Bonds to tooth structure
6. Low shear strength
7. Dimensional change (shrinks on setting, expands with water
sorption)
8. Brittle
9. Lacks translucency
10.Rough surface texture
61
MECHANISM OF ADHESION
Bonding of glass ionomer is achieved in part by
mechanical retention and in part by chemical
reaction.
63
SURFACE PREPARATION
Clean surface is essential to promote adhesion.
A pumice wash to remove the smear layer.
Then apply 10% polyacrylic acid solution for 10 to 15 seconds,
followed by a 30 seconds water rinse. This procedure si called
conditioning
Then the surface is dried but not be desiccated and prevention by
saliva and blood is taken care of.
Mixing
The recommended P:L ratio is in range of 1.25 to 1.5g of powder per
1mL of liquid.
A cool, dry glass slab may be used to slow down the reaction and
extend working time. The glass slab is not used if it is cooled below
dew point as the moisture condensation on glass slab can alter the
acid water balance needed for proper reaction.
The powder and liquid is just dispensed before mixing.
64
Mixing Time:
The mixing time should not exceed 45 to 60 seconds.
At this time, the mix should have a glossy surface. The
shiny surface indicates the presence of polyacid that has
not participated in the setting reaction.
This residual acid ensures adhesive bonding to tooth
enamel.
Setting Time:
Type I 4-5 min
Type II 7 min
65
BAND CEMENTATION:
Depends on the most important of which is fit. The better
fit of the band, the less chance for failure most bands
Bands can be mechanically roughened or microetched on
the inside to increase adhesion between the cement and
the band material.
Once the cement is mixed the bands internal side is
covered with cement. The band is seated, and excess
adhesive is removed, the edges of band are protected by
varnish provided by manufacturers.
Three parameters that must be controlled to ensure
success
Conditioning of tooth surface.
Proper manipulation.
Protection of cement during setting.
66
Why GIC???
Major advantage- relatively easy to use and to remove
Anticariogenic effect
67
Advantages
High compressive strength
Adhesive to enamel
Resistance to microleakage
Low exothermic reaction
Compatibility with the oral tissues.
Ability to leach fluoride ,fluoride recharge( Reservoir effect)
Dimensional stability
Disadvantages
Brittleness
Susceptibility to dehydration
Moisture sensitivity during placement
Low tensile strength
Esthetic problems due to insufficient translucency
68
RESIN-MODIFIED GLASS IONOMER CEMENT
Also known as glass-ionomer hybrid cements/hybrid
ionomer cements
Developed to overcome Moisture sensitivity and low early
strength of conventional GICs
Set through combination of acid-base reaction and
photo/chemical polymerization.
Addition of hydrophilic monomer e.g., HEMA to the liquid of
GIC
Can be grouped further as:
Self Cure RMGIC
Light cure RMGIC
Tricure RMGIC
Inclusion of resin monomer to form a protective matrix in
which the regular cement setting takes place
69
COMPOSITION
Powder:
Alumino-silicate glass particles
Polymerization initiator
Chemical initiator (Benzoyl peroxide) in case of chemically-
activated polymerization
Photo-initiator (Camphroquinon) in case of light- activated
polymerization
Both in case of tri-cured material
Liquid:
Aqueous solution of Poly-alkenoic acid
Poly-acrylic acid having some carboxylic groups modified with
HEMA monomer or hydrophilic monomer
70
Setting
The initial and rapid setting of the material is provided
through polymerization of resin monomer
71
Advantages over conventional GIC
The diametral tensile strength higher than those of
conventional GICs
Higher strength and fracture toughness than that of
conventional GIC
Lower solubility of the freshly-set material
Possibility for immediate finishing and polishing
No need for resin or varnish coating due to initial rapid set
and strength
Disadvantages
These materials release levels of fluoride comparable to
those of conventional GICs but slightly less.
Loss of translucency of GIC
72
RESIN MODIFIED GIC
73
COMPOMERS( Polyacid modified resins)
First Compomer- introduced in 1993- DYRACT (Dentsply)
76
Advantages
No mixing required
Ease of technique
Excellent handling
Less susceptible to dehydration
Higher bond strengths than RMGIC
Stronger than GIC
The newer compomers even bond chemically to band
material than zinc phosphate or GIC.
Non-tooth colored band cements in blue and pink color are
available for clean up process after the bands are removed.
Disadvantages
Bonding agent required
More leakage than RMGIC
Expansion due to water sorption
Limited fluoride uptake and release
77
Conclusion
78
Bibliography
Orthodontic Materials Scientific and Clinical Aspects.
William A. Brantley Theodore Eliades. Thieme
Phillips Science of Dental Materials. K J Anusavice. 12th
Edi. SAUNDERS An Imprint of Elsevier.
Dental Materials and Their Selection. William J
Obrien.2nd Edi. Quintessence Publishing Co, Inc.
Tooth Coloured Restoratives- Principles and
Techniques. Harry F. Albers. 9th Edi. BC Decker Inc
Restorative Dental Materials. R.G. Craig, J.M. Powers. 11th
Edi.Mosby
Three Cements Used for Orthodontic Banding of
Porcelain Molars. Tracy Heriona; Jack L. Ferracaneb; David
A. Covell Jrc. Angle Orthod,2007.77;(1) ,94-99.
An evaluation of silicophosphate as an orthodontic
cement.Clark RJ, Phillips RW, Norman RD. Am J Orthod.
1977 Feb;71(2):190-6.
79
THANK YOU
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