Cement_guide_en_short

Guide to Cementation
Your practice is our inspiration.™ Guide to Cementation
Clinical Guide

Cementation in Dentistry Prosthodontic Procedure - All you need is Kerr Mechanical & Physical Properties Temporary Cementation Permanent Cementation Adhesive Cementation Review When to use our cements Author Biographies Your practice is our inspiration.™ All you need is Kerr Guide to Cementation The act or process of attaching by means of cement In dentistry we have been using different forms of We at Kerr hope you will enjoy reading our guide.
cements for as long as there have been We strive to deliver to you the highest quality in all restorations needing to be fixed permanently to our products that you use everyday.
tooth structure. Over the past decades there hasbeen a huge barrage of cementation products Your practice is our inspiration! available to dentists. Also specializing for use indifferent fields of dentistry;restorative,orthodontic,endodontic, surgery,implant,etc. Thus making the task of choosingwhich type of cement to use, how to use it, AND Todays dental practice can vary from a single for which indication very confusing.
operator working from one chair in Nanaimo to a In recent years there has been an influx of multi associate group practice in Zürich. All have prosthetic restorative materials to choose from.
the expectation of receiving the highest quality in Choices ranging from traditional PFM, All Ceramic, products to give to their patients. With so many Zirconia, Indirect Composite resin and CAD-CAM different types of procedures and clinical decisions milled products have become the standard to be made, clearly one type of cement and/or luting product cannot satisfy all situations.
Therefore it is imperative that dentists have manytypes of cements available in their practice.

Cementation in Dentistry
Inspired by. "Ideally, dental cements should adhere to tooth structure as well asrestorative materials. They should exhibit the following characteristics:• resist functional forces• be insoluble in oral fluids• be effective while maintaining a low film thickness• be compatible with pulp tissue• exhibit anticariogenic properties• be easy to manipulate and clean up To date no one cement has achieved all of these properties together, butthe current offering of resin cements demonstrate high strength, relativelylow solubility, self or dual cure functions; reduced or eliminated post-opsensitivity, and relative ease of handling. Kerr dental cements have been apart of my daily practice for over 25 years" Dr. Isaac Novak Your practice is our inspiration.™

All you need is Kerr The Prosthodontic Procedure
Guide to Cementation Impression
Impression
for study models
Snow White Plaster type 2 of models
and Plasters
Orthodontic Model Mix Stone Hydrocal Denture Model Stone Impression
Beavers Carbide Jet Burs BlueWhite Diamond Burs Beavers Carbide Jet Bur BlueWhite Diamond Bur Impression
Options: Delivery, viscosity and set time
The perfect
flexible and
for extra mechanical
flow and body
Unidose®
Kerr's unique Unidose delivery offers
dual benefits: targeted syringe
delivery and the elimination of cross-
contamination concerns
Cartridge
Convenient 50 ml cartridges make
mixing & application of Take 1
Advanced precise and easy
Volume
For busy offices, Take 1 Advanced
Volume delivery speeds up
impression taking, reduces hand
fatigue and lowers cost per use
Hand Mix
For instances when a higher
viscosity tray material is desired
and other mixing methods
are unavailable
*LB = Light Body, RB = Regular Body, Med/Mon = Medium/Monophase, HB = Heavy Body Your practice is our inspiration.™ All you need is Kerr The Prosthodontic Procedure
Guide to Cementation Impression
Take 1 Advanced Bite Registration Crown & Bridge
Temporary
Temporary
Crown & Bridge
Temporary
Veneers Step:
Hawe Transparent Strips Permanent
Crown & Bridge
Finishing
& Polishing
Identoflex Porcelain / Ceramic PolishersIdentoflex Diamond Ceramic Polishers Your practice is our inspiration.™ All you need is Kerr Guide to Cementation Mechanical & Physical
Properties.
…what are they and why are they so important
in cementation?
"all mechanical properties are measures of the resistance of a
material to a deformation/fracture under an applied force"
A dental prosthesis is designed with multiple functions in mind. It is a manmade object that is replacing natural teeth lost for any number of reasons.
It needs to be esthetically pleasing for the patient, provide protection ofunderlying teeth, fit into the existing dynamics of the mouth and occlusion,AND be strong enough to last years, resisting the forces of mastication.
Given the fact that in normal biting and chewing the average biting force is170 pounds, it's a small miracle that from a dentist's impression, a dentaltechnician is able to fabricate a piece of functional art so precise! Mechanical Properties
The maximum stress a material can withstand when subjected to The thickness of a cement under certain pressure.
* If the film thickness is too large, it will interfere with the seating of the restoration. * A high compressive strength means the cement can better resist the compressive stress or chewing force. The maximum stress a material can withstand when subjected to tension.
The amount of material soluble in water after the * A high tensile strength means the cement can better resist the tensile stress cured cement is soaked in water for 7 days.
(e.g. experienced when you chew sticky food). * If the solubility is too high, it will weaken the cured cement and cause marginal ditching. Bond Strength
Force, normalized with bonding area, required to separate
Setting Time
two materials bonded together with an adhesive.
Setting time is the time (from the start of mixing) when * A high bond strength will result in a long and lasting restoration. the mixed material is fully hardened. * Once the cement is set, the cement will be strong enough to Shear Bond Strength
withstand the forces of finishing/polishing. Shear force, normalized with bonding area, required toseparate two materials bonded together with an adhesive* A high shear bond strength will result in a long and lasting restoration. pH
is a measure of the acidity or basicity of a solution/material.
* If the pH of the cured material is too low (or acidity too high), the bond
may not be durable as the cement may undergo degradation. A measure of rigidity of the material.
* Its importance is unknown for a cement. Basically you do not want a cement that is too soft as it will not adequately support the restoration under stress. Measures the capacity of a material to absorb x-ray.
* A high radiopacity for a cement will allow it to show when examined with x-ray so that it will not be mistaken as gap or void. Flexural Strength
The maximum stress a material can withstand when subjected to bending.
* A high flexural strength means the cement can better resist the bending stress when the
Eugene Qian, Ph. D. tooth is flexed. Principle Scientist, Dental Materials Center, Kerr Corporation Your practice is our inspiration.™ All you need is Kerr Guide to Cementation Inspired by. TempBond has been a staple in my practice since the start of my dental career. It is easy to use,has sufficient strength over a relatively short period of time to withstand mastication and keeptemporary crowns and bridges in place while the eugenol base soothes pulpal tissue. For patientsallergic to eugenol the TempBond NE version is equally effective. If a concern arises because arestoration's bonding ability may be affected by eugenol, the TempBond Clear is a great choice.
With availability in automix syringe delivery, the convenience of this product takes a seat, second tonone.
Dr. Isaac Novak TempBond™
Temporary Cement
TempBond™ temporary cement for trial restorationsor temporary crowns and bridges withstands mas-tication, seals the restoration and prevents seep-age, yet is easy to remove. Non-eugenol TempBond NE™ will not inhibit thepolymerization of permanent resin cements andacrylic temporaries. And resin-based TempBondClear™ with Triclosan is the most translucent provi-sional cement in the market for superior esthetics.
• Delivery choices. Unidose®, tubes and new
automix syringe offer flexibility in deliveryoptions. Case courtesy of Dr. Tony Soileau TempBond was developed in 1961 based on zinc • Flows and mixes easily. Delivers optimal
oxide-eugenol chemistry, a classic setting consistency for solid, complete seating of reaction with over 100 years of clinical history.
Then in 1989, Kerr introduced TempBond NE with • High bond strength. Heightens patient
eugenol-free zinc oxide, substituting carboxylic confidence. Prevents leakage and sensitivity to acids in place of eugenol. And TempBond Clear with Triclosan incorporates a unique redox • Easy to remove. Enhances patient comfort.
initiator system and low refractive index fillers for Clinically proven
Minimizes potential for damage to the prep or excellent color stability and high translucency.
performance you trust
Your practice is our inspiration.™ All you need is Kerr Cementation Procedure Inspired by. Zirconium-based porcelain crowns represent an alternative restorative material thatenhances the dentist's and technician's ability to provide durable, aesthetic and functionalrestorations in the anterior or posterior region of the mouth especially when metal-freerestorations are a primary desire of the patient. I recently used Maxcem Elite to cement Lava®crowns for a patient. Excess cement was easily removed from the margins and accomplishedwithin a short amount of time before final curing with the DEMI curing light for 10 seconds.
No finishing of the cement was necessary along the margins.
Dr. Ara Nazarian All trademarks are property of their respective owners.
Maxcem Elite™ in Clinical Cases
Zirconia Crowns, Teeth 17-27
Patient case pictures courtesy of Dr. Ara Nazarian Patient's original smile Patient's original restorations with fracture lines Patient's teeth prepped with Expasyl for and failing margins gingival retraction before taking impressions Cementing Lava® crown using Maxcem Elite Final zirconia restorations seated using Patient pleased with final results of her smile All trademarks are property of their respective owners.
Your practice is our inspiration.™ All you need is Kerr Cementation Procedure Single component; Self-etch resin cement system Maxcem Elite Review
Dr. Ara Nazarian
Now is a great time to practice aesthetic and According to the manufacturer, some features and cosmetic restorative dentistry. Today, unlike ever benefits include the following: before, clinicians and technicians have a variety of indirect restorative materials from which to choosein order to quickly, easily and predictably restore a Fortunately, Maxcem™ Elite by Kerr is a single • High bond strength and compatibility to common patient's smile.
component; self etch resin cement system that dental substrates eliminates multiple steps when bonding indirect • Ability to tack-cure immediately restorations. Clinicians have everything they need have been placed when strength and durability in for etching, priming and bonding in one syringe.
• Applicable for common indirect restorations the posterior region were required, and/or in the Maxcem™ Elite bonds tenaciously to all dental anterior region when complete isolation from • Patented Redox System substrates while maintaining excellent mechanical moisture could not be achieved, thereby and esthetic properties. The cement is eliminating all-ceramic restorative possibilities.
conveniently dispensed directly into the restoration Esthetically, all-ceramic restorations have been or cavity preparation using a dual auto mix this author's ideal choice for aesthetics, but syringe. Optional curved tips are also available for • High bond strength without adhesive needed problems of sensitivity have developed because of inlay/onlays and post placement applications. No • Saves time at patient chair side errors that can occur during the multiple steps more 90-second wait before tack curing, no hand • No need to refrigerate required for bonding, especially when placing mixing and no refrigeration required. Using the • Easy clean-up several units of restorations at one seating.
amine free chemistry similar to its cousin NX3, • No hand mixing required Maxcem™ Elite has superior color stability enablingits use under esthetic restorations anywhere in the • Anterior, posterior / ceramics, PFMs and mouth. So whether you decide to use this cement CAD/CAM materials for zirconia, all ceramic, indirect composite, or • Color stability, esthetic, works with all substrates even porcelain to metal restorations, the process from opaque to translucent is as easy as 123! Shear Bond Strength (MPa) of Maxcem Elite
to Various Substrates Self-Cured
Depending on the substrates, bond strengths have been recordedbetween 22-36 MPa. When combined with OptiBond® All-In-One, Kerr's research team found dentin and enamelbond strength of Maxcem™ Elite to be 35MPa and 30MPa, respectively.
When combined with OptiBond Solo™ Plus, Kerr's research team founddentin and enamel bond strength of Maxcem™ Elite to be 35MPa and33MPa, respectively. The following chart illustrates these differentlevels.
24-hour testing. Internal data. Available upon request.
As dentists, we are always looking for something that is quick and simple to use yet veryeffective. Maxcem™ Elite is indeed an enhanced and better version of the traditionalMaxcem™ cement; one of the first to introduce the self etch resin cements to the dentalprofession. Now with increased bond strengths and the ability to spot tack, Maxcem™Elite will prove to be a new enhanced leader in the field.
Your practice is our inspiration.™ All you need is Kerr Cementation Procedure Superior Bond Strengths and Compatibility To All Common Dental Substrates
Maxcem Elite is indicated for cementation of anterior or posterior composites, ceramics, PFMs and metalrestorations, CAD/CAM materials, zirconia-based restorations, posts, and cementing crowns to implants.
Maxcem Elite self-etch, self-adhesive resin Maxcem Elite's enhanced bond strengths are achieved as follows: cement for indirect restorations • Optimized amount of GPDM and other adhesive monomers to improve wettability.
• Modified resin matrix system to reduce surface tension to etch more effectively, hence eliminating the 90-second wait of previous generation of Maxcem, in addition to enhancing shelf life so no refrigerationis needed.
Maxcem Elite™ is Kerr's newest innovation in the • Re-designed filler system to promote a more intimate contact with tooth.
self-adhesive cement space. The market, whilecontinuing to embrace the technology of thisrelatively new category, still harbors concerns The Proprietary Redox Advantage
Most self-cure or dual-cure resin cements use the bonding capabilities of cements that bypass Maxcem was the first in the self-adhesive a benzoyl peroxide (BPO) and tertiary amine the bonding step. Maxcem Elite is formulated to cement category to offer what is truly the pair to initiate polymerization and curing, ease this concern by taking the science behind easiest to use and fastest procedure on the resulting in discoloration over time due to self-adhesive cements and evolving the chemistry market with the dual-syringe delivery system.
oxidation of amine. Now with an amine-free to ultimately provide bond strengths and superb Maxcem Elite continues this legacy with automix redox initiator system and optimized resin esthetics that surpass competitive claims.
tips that now come with optional curved tips – matrix, Maxcem Elite, together with NX3, intraoral tips for inlays/onlays, and root-canal Kerr's traditional resin cement, are the first tips for post cementation – to dispense cement truly color-stable resin cements in the market.
in those hard-to-reach places in the mouth. No Maxcem Elite's color stability and high hand mixing, and no separate activation, mixing translucency enable esthetic integrity and or dispensing device required.
allow for cementation of both anterior andposterior restorations, making it a universal Maxcem was famous for its cleanup. Now, cement that helps simplify and minimize the Maxcem Elite's cleanup is just as fast as excess office inventory.
cement is easily removed after reaching a gelstate. Maxcem Elite comes with a techniqueguide that summarizes the full instructions for Taking simplicity
use, making the cementation process an easyand user-friendly experience.
to the next level
Maxcem Elite™
Application Guide
Maxcem Elite is indicated for final
cementation of:
• All-ceramic (including zirconia or alumina strengthened, and Cerec) and compositecrowns, bridges, inlays and onlays • Metal and porcelain fused to metal crowns, bridges, inlays and onlays • Prefabricated metal or fiberglass posts 1) Preparation
• Dispense cement directly into 4) Final cure
• Remove provisional restoration. restoration or tooth preparation • Light cure all surfaces including using intra-oral tip. For posts, • Remove temporary cement and margins using Demi curing light dispense cement directly onto debris using OptiClean or your for 10 seconds. See footnote for Peerless Post or your post of instrument of choice. Rinse and recommended curing times for choice, or dispense directly into lightly air dry.
other curing light models.* canal using root-canal tip. • Try in restoration to ensure • For non-translucent restorations, 3) Placement
allow cement to self-cure for 4-5 • Seat restoration onto preparation.
• Rinse thoroughly and lightly air Hold in place with light pressure. dry. Do not desiccate. 5) Finish and polish
• Allow cement to flow from all • Polish margins with Gloss Plus • Pre-treat final restoration accor- discs, cups or points. Use ding to manufacturer's directions. • Remove excess cement. Excess HiLusterPlus polishers for a final can be removed in gel state (gel high luster shine. • Select desired shade of Maxcem state is achieved in 2-3 minutes). • Check occlusion. Immediate tack-curing to hastengel state is optional. * Caution: Uncured methacrylate resin may cause contact
• Remove cap and bleed cartridge dermatitis and damage the pulp. Avoid contact with skin, eyes once before initial use. and soft tissue. Wash thoroughly with water after contact.
Caution: Kerr Gel Etchant contains Phosphoric Acid. Avoid
contact with skin, eyes, and soft tissue. In case of contact with
• Place appropriate mixer on dual skin or eyes, flush immediately with water. Get medical attention syringe cartridge. Mixer with wide for eyes. Do not take internally. * Recommended Cure Times: Demi and L.E.Demetron II: 10
opening is only for use with seconds L.E.Demetron I and Optilux™ 501: 20 seconds For allother lights, see manufacturer's recommendation. Maxcem Elite is indicated for final cementation Your practice is our inspiration.™ All you need is Kerr Cementation Procedure Maxcem Elite™ in Clinical Cases
Premise Indirect Composite Inlay, Tooth 16
Case courtesy of Dr. Stephen Poss 1) Shade selection for optimal esthetics 2) Original amalgam restoration 3) Restoration margins should not coin- 4) Final impression cide with static occlusal contacts (Take 1 Advanced impression material) 5) Create temporary with light cure 6) Inlay on model 7) Isolation of prepped tooth with 7) Clean restoration. Etch inlay with temporary filling material and phosphoric acid if ceramic. If cement into place (Fill-In Temporary restoration is a lab resin, blast material & TempBond Clear used) internal surface with AluminumOxide 9) Coat internal aspect of the ceramic 10) Place thin coat of Maxcem Elite 11) Seat the restoration 12) Carefully floss and light cure the with silane (Kerr Silane Primer) on the inlay covering all aspects restoration for 2 seconds to of the internal surfaces obtain cement gel state 13) Remove access and floss again 14) Check occlusion. Clean excess and if 15) Finish/polish restoration with cups 16) Final restoration necessary adjust restoration with a and brushes (Occlubrush used) fluted carbide bur Your practice is our inspiration.™ All you need is Kerr Cementation Procedure Adhesive Cementation Prof. Francesco Mangani
The cementation of an indirect restoration can be The necessity of finding alternatives to amalgam carried out with light-curing, self-curing or dual-cur- and the growing demand of patients for highly aes- thetic restorations have brought an increase in pop- Light-curing luting cements are generally available ularity of resin composite materials for dental Today, adhesive cementation represents a pre- as a single paste contained in an opaque, light- restorations. These materials have proven effective dictable technique, which can be used with both proof syringe. They can be easily handled, allow for in terms of aesthetic results and biomechanical indirect resin composite and all-ceramic restora- a better control of the setting times and ensure high properties. Polymerization shrinkage1 is the main tions plus endodontic posts. This procedure is quality margins, thanks to their high filler content.
drawback of resin composites and it directly essential to guarantee a favorable long-term prog- However, light-activated curing is a drawback in depends on filler content. In large cavities, especial- nosis. However, it is discussed here in terms of deep cavities, as the UV light may fail to activate ly when the cervical margins are located in dentine, selection of the most suitable materials and tech- benzoyl peroxide, leaving part of the luting cement the polymerization of large amounts of filling mate- niques. The criteria which must be taken into with a low degree of conversion. This will influence rial may cause a higher shrinkage stress, resulting in account in inlay cementation can be divided in: its mechanical properties. Another disadvantage of marginal gaps and defects2, which open the way to • Mechanical: to achieve a micro-mechanical and
these materials is their high polymerization shrink- bacterial micro-infiltration, secondary caries, pulp irritation, post operative sensitivity and marginal • Structural: to increase the strength of the restora-
Among the advantages of self-curing or dual-curing luting cements is their optimal monomer conver- A promising method for reducing the problem of • Biological: to produce a tight marginal seal
sion, even at low radiant energy intensity; their dis- polymerization shrinkage is the use of a thin incre- between the tooth and the restoration.
advantage is their extreme flowability. Moreover, the ment of resin luting material in conjunction with • Aesthetic: to achieve a perfect colour match
need to mix two components (i.e., powder – liquid indirect restorations, such as veneers, inlays, between the tooth and the restoration.
or paste – paste) is responsible for porosity or void onlays, overlays4. This thin layer of material will be formation and air bubble inclusion, which may com- the only part of the restoration subjected to poly- promise the bond between the filling material and the tooth substrate.
Self-curing luting cements allow for a lower control In vitro investigations have shown that the degree of on curing time, but ensure a lower shrinkage stress, conversion of a light-curing micro-hybrid compos- which is partially improved by viscous flow.
ite, pre-heated in an oven at 54°C and used in Light-curing and self-curing luting cements can set increasingly thicker restorations (2, 3, and 4 mm even in those areas which cannot be reached by UV thickness) is similar to that of dual-curing materials light. However, in this case, the working time starts thicker inlays, has clearly shown the inadequacy of under the same radiant energy, regardless of the when the two components are mixed together.
this class of material, as they fail to achieve proper light source (LED or halogen)20. Therefore, this The physical and mechanical properties of com- curing when used to cement a restoration with a method is particularly interesting, as it combines posite materials are closely related to the degree of 3mm thickness or higher11. The only indication is the benefits of light-activated materials with a high monomer conversion into polymer6,7,8. In light-acti- veneer cementation, as their lower thickness per- degree of monomer conversion. Moreover, this vated systems, the degree of conversion decreases mits the radiant energy to reach the composite technique is used in the cementation of anterior and as the distance between the curing light and the fill- material and start the curing process. It has been ing material increases, since the radiant energy is shown that light-curing composite pre-heating reduced when passing through the restoration9,10.
increases the degree of monomer conversion, This result, supported by the studies on the degree which improves the properties of the luting materi- of conversion of light-curing flowable resin com- al, resulting in better homogeneity and handling of posites used in the cementation of increasingly the material12-19.
Caughman WF, Caughman GB, Shiflett RA, Rueggeberg F, Schuster GS. 15 Lecamp L, Youssef B, Bunel C, Lebaudy P. Photoinitiated polymerization of a Correlation of cytotoxicity, filler loading and curing time of dental compos- dimethacrylate oligomer: 1. Influence of photoinitiator concentration, tem- Ciucchi B, Bouillaguet S, Delaloye M, Holtz J. Volume of the internal gap ites. Biomaterials 1991;12:737–740. perature and light intensity. Polymer 1997;38:6089–6096 formed under composite restorations in vitro. J Dent 1997;25:305–312. Musanje L, Darvell BW. Curing-light attenuation in filled resin restorative 16 Lovell LG, Newman SM, Bowman CN. The effects of light intensity, tempera- Dietschi D, Scampa U, Campanile G, Holtz J. Marginal adaptation and seal materials. Dent Mater 2006;22:804–817. ture, and comonomer composition on the polymerization behavior of of direct and indirect class II composite resin restorations: An in vitro evalua- dimethacrylate dental resins. J Dent Res 1999;78:1469–1476. tion. Quint Int 1995;26:127–138. 10 Obici AC, Coelho Sinhoreti MA, Frollini E, Correr-Sobrinho L, de Goes MF, Pessanha Henriques GE. Monomer conversion at different dental compos- 17 Mak Y, Lai SCN, Cheung GSP, Chan AWK, Tay FR, Pashley DH. Micro-ten- Browne RM, Tobias RS. Microbial microleakage and pulpal inflammation: A ites using six light-curing methods. Polym Test 2006;25:282–288. sile bond testing of resin cements to dentin and an indirect resin composite. review. Endod Dent Traumatol 1986;2:177–183. Dent Mater 2002;18:609–621. 11 Vieno S, Acquaviva PA, Gagliani MM, Re D, Augusti D, Cerutti A. Blankeneau RJ, Kelsey WP, Cavel WT. A direct posterior restorative resin MicroRaman investigation of luting cements in indirect composite restora- 18 Stansbury JW. Curing dental resins and composites by photopolymerization. inlay technique. Quint Int 1984;5:515–516. tions. Atti del 85th IADR General Session and Exhibition, New Orleans, J Esth Dent 2000;12:300–318. march 2007 Ferrari M, Dagostin A, Fabianelli A. Marginal integrity of ceramic inlays luted 19 Trujillo M, Newman SM, Stansbury JW. Use of near-IR to monitor the influ- with a self-curing resin system. Dent Mater 2003;19:270–276. 12 Daronch M, Rueggeberg FA, Hall G, De Goes MF. Effect of composite tem- ence of external heating on dental composite photopolymerization. Dent perature on in vitro intrapulpal temperature rise. Dent Mater Oréfice RL, Discacciati JAC, Neves AD, Mansur HS, Jansen WC. In situ eval- uation of the polymerisation kinetics and corresponding evolution of the 20 Acquaviva PA, Cerutti F, Adami G, Gagliani M, Ferrari M, Gherlone E, Cerutti mechanical properties of dental composites. Polym Test 2003;22:77–81. 13 Dickens SH, Stansbury JW, Choi KM, Floyd CJE, Photopolymerization kinet- A. Degree of Conversion of Three Composite Materials Employed in the ics of methacrylate dental resins. Macromolecules 2003;36:6043–6053. Adhesive Cementation of Indirect Restorations: A Micro-Raman Analysis. Ogunyinka A, Palin WM, Shortall AC, Marquis PM. Photoinitiation chemistry J Dent 2009;37(8):610-5 affects light transmission and degree of conversion of curing experimental 14 Draughn RA. Effects of temperature on mechanical properties of composite dental resin composites. Dent Mater 2007;23:807–819. 12. dental restorative materials. J Biomed Mater Res 1981;15:489–495. Your practice is our inspiration.™ All you need is Kerr Cementation Procedure Clinical cementation procedures for predictable aesthetic results: NX3™ Review and Clinical Case
tips & tricks
Dr. Montri Chantaramungkorn
Acceptable clinical performance of dental cements • Proprietary amine-free initiator system and opti- An aesthetic resin cementation appointment requires an adequate resistance to dissolution in the mized resin matrix.
may be divided into six steps: oral environment, a strong bond through mechanical • Simplified delivery: a dual-cure auto-mix syringe Step 1_ Try-in and shade control of the laboratory- interlocking and adhesion, high strength under ten- eliminates hand mixing.
sion, good manipulation properties, such as accept- • Light-cure applications: a cement for veneers and Step 2_ Adhesive treatment of the inner surface able working and setting times, and a biologic indications requiring unlimited work time.
Step 3_ Adhesive treatment of the tooth surface acceptability for the substrate.
• Bonds to all substrates: excellent adhesion to Step 4_ Adhesive luting Resin-based cements are generally used for aesthet- dentin, enamel, CAD/CAM blocks, ceramic, porce- Step 5_ Control and adjustment of the occlusion ic restorations (ceramic or resin based) and have lain, resin and metal.
Step 6_ Finishing and polishing become popular because they have addressed the • Self-etch or total-etch: bonding protocol compati- disadvantages of solubility and lack of adhesion not- bility. No dual-cure activator required.
A 27-year-old male patient was presented with ed in previous materials. Restorative • Superior color stability: long-term esthetics for both unsightly black gingival shine through resulting from dentistry is constantly undergoing change, driven in dual-cure and light-cure cements.
dull PFM crowns in both maxillary central incisors part by new clinical applications of existing dental • Optimal handling: easy clean-up in gel state. The (Figs. 1, 2). After treatment, the newly replaced leucite materials and the introduction of new materials. Kerr following article discusses aesthetic adhesive pro- reinforced glass ceramic restorations (Empress has recently introduced NX3, a new third generation cedure techniques for the new NX3 in luting leucite Esthetic) (Fig. 3) cemented with NX3, are harmo- dual-cure resin cement, with the following features: reinforced glass ceramic restorations with pre- niously integrated with the adjacent teeth and the gin- dictable aesthetic results.
gival architecture (Figs. 4, 5). Step 1: Try-in and shade control of the laboratory-made
Step 2: Adhesive treatment
restoration
of the inner surface
Marginal adaptation and proximal After the try-in gel was thoroughly contact of the laboratory-made washed off and gently dried with restoration were first checked on oil-free compressed air, the inner the die-cast model. The better the side of the silica-based ceramic fit, the easier excess luting resin was conditioned with 5 percent cement can be removed, as there hydrofluoric acid for 60 seconds.
is less danger of tearing the luting This helps to promote optimal mor- composite out of the luting space phological change of the surface during excess removal (Fig. 6). The for the penetration of the silane try-in gels matched both dual- primer (Fig. 9). For this type of and lightcure cements, a huge ceramic, silane acts principally as advantage when it comes to aes- promoter of wettability on the thetic restorations. The intro kit roughened surface and for the suc- contains three colors – yellow, cessive application of the luting clear and white – however, other agent (Fig. 10).
shades are also available. In my The shiny aspect of the inner surface was visible after drying off the silane primer with hot air for two practice, clear, white and minutes (Fig. 11). After the surface adhesive treatment and before insertion, the restoration had to be opaque-white are used the most.
protected from light (Fig. 12).
Clear try-in was used while closely matching the work piece to theadjacent tooth (Fig. 7).
Step 3: Adhesive treatment of the tooth surface
The fit and shade control was verified by using the try-in gel. This OptiClean was used for the complete removal of temporary cement and debris. It removes all traces of step is quite helpful in determining temporary cement and delivers a perfectly clean cementation surface of the entire tooth preparation.
the final shade aspect of the Used on a slow speed handpiece, OptiClean is a singleuse instrument with a 1.6 mm diameter tip for restoration, luted with the con- excellent interproximal access (Fig.
current shade of resin luting. In 13). After the total removal of the this case, clear shade try-in paste temporary cement, the operating was used (Fig. 8).
field and tooth preparation surface Only minimal adjustments of the was properly prepared with the workpiece are possible at this application of plumber tape to the moment, otherwise the restora- adjacent teeth. The gingival was tion will have to be sent back to the laboratory for correction and retracted with a #00 Ultrapak® the luting session will have to be postponed.
retraction cord (Fig. 14). All trademarks are property of their respective owners.
Your practice is our inspiration.™ All you need is Kerr Cementation Procedure According to the manufacturer, NX3 is compatible with self-etch (OptiBond All-In- etched surface was bonded to a proper moist condition. OptiBond FL Prime was One) and total-etch adhesives (OptiBond Solo Plus, OptiBond FL) and obtains high applied on the conditioned surface in a light scrubbing motion for 15 seconds.
bond strength whether the cement is lightcured or dual-cured. In this case I chose a Another drying session of five seconds got rid of the volatile solvent. At this point the total-etch adhesive (OptiBond FL). A total etch of the enamel dentin and resin surface dentin/enamel surface should have a slightly shiny appearance (Figs. 16–19). Light of the composite core was done for 15 seconds with Kerr gel etchant 37.5% phos- curing is not advisable! The surface was then ready for one adhesive luting of the phoric acid. Afterwards, copious amounts of water were used for rinsing until the restoration with NX3 cement dual cure.
etchant was completely removed (Fig. 15). After rinse off and gentle air drying the Step 4: Adhesive luting
NX3 dual-cure resin cement was then easily dispensed on the previously prepared inner surface of
the restorations (Fig. 20). The placement of the restorations onto the adhesively prepared tooth sur-
face was done manually by gently pressing at the incisal edge (Figs. 21, 22). This was done immedi-ately after the cement was dispensed.
Excess cement in the gel state was easily removed with a sharp interproximal carver (Fig. 23). Directfocus of the operative light on the restoration during placement should be avoided. At this point, morepressure was exert to ensure that the restoration was fully seated and that the thickness of the cementwas as thin as possible.
After all thee x c e s sc e m e n tand theretractioncords hadb r e m o v e d ,all surfaces were light cured for 20 seconds each, using a Hi-power LED curing device (Figs. 24–27). Even thoughdualcure resin cement was used, light curing helped to ensure better polymerization and better bonding to thetooth surface. When using dual-cure cements, clinicians should delay the light-curing procedure to the maximumtime clinically possible. That way a maximum degree of conversion of the resin cement may be achieved after light Conclusion
activation, reducing the risk of excessive water uptake.
The ideal luting agent should guarantee:• a durable bond between the involved structures Step 5: Control and adjustment of the occlusion
and provide a good marginal adaptation The adjustment of the occlusion was safely executed after the restorations were adhesively luted to the teeth. This as well as additional attributes like can be done by checking for a hi-spot in centric and protrusive movement of the jaw. A hi-spot can be corrected • optimal biomechanical properties, with a fine diamond in a hi-speed handpiece (Figs.28–30).
• low solubility in the oral cavity,• radiopacity, Step 6: Finishing and polishing
• increased working and setting time for easy The ceramic surface that was adjusted by grinding was then polished back to high-gloss finish with OptraFine (Ivoclar Vivadent) a new, high-performance diamond polishing system for ceramic materials, which affords a • adequate viscosity for complete seating, and unique combination of highly efficient application and perfect polishing results.
• optimal esthetic properties.
Interproximal ceramic margins under the gum line were finished and polished to a smooth transition with EpitexStrips (GC). These strips are ultra-thin because abrasive particles are not bonded to the strip with adhesive.
Currently, no commercially available luting cement This also allows easier access in tight contact points and helps minimize gingival damage.
is ideal for all situations. NX3 was created to meetthose aforementioned requirements. Clinicianscould work universally with this product incementing aesthetic crowns, veneers, inlays,onlays, CAD/CAM restorations with efficient andmore predictable esthetic results.
The literature list is available from the publisher This article was originally published in Cosmetic Dentistry Vol. 2, Issue 1/2008 Your practice is our inspiration.™ All you need is Kerr Cementation Procedure Colour Stability of Dual-Cure Resin Cements – Clear Shade
Stability
CAD/CAM restorations such as Vitablocs™,
ProCAD® and Zirconia are more opaquethan traditional porcelain restorations.
Therefore, using just a light-cure cement is 28 weeks in
a concern due to inadequate light 37°C water
NX3 Nexus® Third Generation is an esthetic penetration. But with NX3, for the first time, permanent cement that represents a Product 1
Product 2
Product 3
you not only get the reliable curing of a breakthrough in resin cement technology.
dual-cure resin cement but more Employing a proprietary redox initiator system importantly – you get unmatched color Internal data. Available upon request.
and a well-balanced resin matrix, NX3 retains all stability due to Kerr's proprietary redox initiator system.
the desirable attributes a resin cement has tooffer – color stability, high bond strengths, good Breakthrough technology is the reason behind the outstanding performance of NX3. Most resin cements on mechanical properties, low water solubility and the market today use a benzoyl peroxide (BPO) and tertiary amine pair as their redox initiator system to initiate good translucency. Universally indicated for all polymerization and curing – a system inherent with problems as it compromises the esthetics of ceramic indirect applications including veneers, NX3 restorations. The unique redox initiator system in NX3 eliminates these problems.
dual-cure and light-cure cements deliver Initiator systems using BPO/amine have two significant color-stability flaws. First, the catalyst paste on its own unmatched esthetics, excellent handling will progressively discolor (yellowish tint) upon storage on the shelf. Second, the self-cured or dual-cured properties, enhanced adhesion to all substrates cement will progressively discolor over time, compromising long-term esthetics. The proprietary redox initiator and great versatility. NX3 has excellent adhesion system present in NX3 offers significant advantages over BPO/amine initiator systems, eliminating the to CAD/CAM blocks in addition to dentin, undesirable discoloration for a more esthetic restoration.
enamel, ceramic, porcelain, resin and metal.
• Optimal handling. Easy cleanup in gel state.
• Simplified delivery. Dual-cure automix syringe eliminates hand mixing.
• Light-cure applications. Cement for veneers and indications requiring unlimited work time.
• Self-etch or total-etch. Bonding protocol compatibility. No dual-cure activator required.
• Superior color stability. BPO and Amine-free initiator system offers long-term esthetics.
All trademarks are property of their respective owners.
Bonding to Composite and
Ceramic Substrates
NX3, which requires an adhesive, achieves excellent
bond strengths and is universally indicated for all
indirect applications – all ceramic-based
restorations, including CAD/CAM blocks, zirconia-
/alumina-strengthened ceramics, and Premise
Indirect – whether NX3 is light-cured or self-cured.
Through the powerful combination of a novel acid-resistant redox initiator system and a unique, well- Internal data. Available upon request. All trademarks are property of their respective owners.
balanced resin matrix, NX3 eliminates theincompatibility issue that has plagued most resincements. The end result is a cement compatiblewith the newer generation acidic adhesive systems,making it well suited for cementing all restorativematerials – even metal-based restorations wherethere is limited or no light accessibility.
24-hour internal testing. Data available upon request. All trademarks are property of their respective owners.
Your practice is our inspiration.™ All you need is Kerr Cementation Procedure NX3™ Application Guide
VENEERS
A.Dip brush. Apply
C.Gently air dry first.
D. Light cure
with scrubbing motion force for at least for 20 seconds.
1.Apply try-in gel to 2.Thoroughly wash veneer and seat. out try-in gel. Air system and
Check color and fit.
dry. Shield silane apply to prep.
Remove veneer.
A.Etch enamel
D. Air dry for 3
primer from ambient light and apply.
for 15 seconds.
E. Light cure for
for 15 seconds.
One set of NX3 try-in gels matches both
dual-cure and light-cure cements.
Proceed to next step below.
For veneer indications –
Use NX3 dual-cure when cementing
1–2 units.
Use NX3 light-cure when cementing
multiple units that need longer work time.
RECOMMENDED CURE TIMES*Demi **L.E.Demetron II 10 seconds 4.Dispense NX3 cement 5.Seat veneer. Spot cure for several 6.Light cure all surfaces 7.Finish and polish.
**L.E.Demetron I (light-cure or dual-cure) seconds. Remove mylar strip. for 20 seconds each.** For all other lights, follow manufacturer's recommendation.
directly into veneer.
Clean excess cement from margins.
A.Dip brush. Apply
C.Gently air dry first.
D. Light cure
with scrubbing motion force for at least for 20 seconds.
1.Apply try-in gel to 2.Thoroughly wash veneer and seat. out try-in gel. Air system and
Check color and fit.
dry. Shield silane apply to prep.
A.Etch enamel
D. Air dry for 3
Remove veneer.
primer from ambient light and apply.
for 15 seconds.
E. Light cure for
for 15 seconds.
NX3 dual-cure cement
exhibits unparalleled color
Proceed to next step below.
stability with its patented
amine-free initiator system.
RECOMMENDED CURE TIMES*Demi **L.E.Demetron II 10 seconds 4.Dispense NX3 cement 5.Seat restoration onto prep, allowing 6.Light cure all surfaces 7.Finish and polish.
**L.E.Demetron I (light-cure or dual-cure) cement to flow from all sides. Tack for 20 seconds each.** For all other lights, follow manufacturer's recommendation.
onto restoration or prep.
cure (1-2 seconds) to facilitatecleanup. Remove excess cement.
Your practice is our inspiration.™ All you need is Kerr Cementation Procedure NX3™ Application Guide
CERAMIC CROWNS
A.Dip brush. Apply
C.Gently air dry first.
D. Light cure
with scrubbing motion force for at least for 20 seconds.
1.Apply try-in gel to 2.Thoroughly wash veneer and seat. out try-in gel. Air system and
Check color and fit.
dry. Shield silane apply to prep.
A.Etch enamel
D. Air dry for 3
Remove veneer.
primer from ambient light and apply.
for 15 seconds.
E. Light cure for
for 15 seconds.
Proceed to next step below.
easy cleanup in
gel state.
RECOMMENDED CURE TIMES*Demi **L.E.Demetron II 10 seconds 4.Dispense NX3 dual-cure 5.Seat restoration onto prep, 6.Light cure all surfaces 7.Finish and polish.
**L.E.Demetron I cement onto restoration allowing cement to flow from all for 20 seconds each.** For all other lights, follow manufacturer's recommendation.
sides. Remove excess cement.
A.Dip brush. Apply
C.Gently air dry first.
D. Light cure
3.Seat restoration dual-cure cement onto prep, allowing with scrubbing motion force for at least cement to flow from for 20 seconds.
all sides. Removeexcess cement.
Proceed to next step above.
1.Select bonding
system and
apply to prep.
A.Etch enamel
D. Air dry for 3
NX3 simplifies your proce-
dure not necessary to use a
for 15 seconds.
E. Light cure for
4.Light cure all sur- 5.Finish and polish.
primer/adhesive on the metal
for 15 seconds.
20 seconds each.** NX3 can be used as a
core build-up materi-
al. Its excellent dark-
cure compatibility
with acidic adhesives
RECOMMENDED CURE TIMES*Demi 1.Prepare post space. 2.Apply NX3 dual-cure 3.Seat post, and vibrate 4.Remove excess 5.Proceed with core Size and fit post.
cement onto post or post to avoid trapped Apply adhesive onto into post prep.
air. Maintain pressure cure all surfaces for **L.E.Demetron II 10 seconds post, air thin, do not until post is stable.
20 seconds each.** **L.E.Demetron I For all other lights, follow manufacturer's recommendation.
Your practice is our inspiration.™ All you need is Kerr Cementation Procedure NX3™ in Clinical Cases
Replacement of Maryland Bridge,
with a zirconia bridge, teeth 13-11.
Porcelain Veneers, teeth 21-23
Case courtesy of Dr. Ara Nazarian 1) Preoperative view of smile 2) Preoperative retracted view 3) Preoperative palatal view 6) Loading of veneers with NX3 7) Postoperative palatal view 8) Postoperative retracted view 9) Postoperative view of smile NX3™ in Clinical Cases
Premise Indirect Composite Inlay, Tooth 46
Case courtesy of Dr. Joseph Sabbagh 1) Preoperative view 3) Gel Etchant internal sufaces 4) Tooth dried ready for bonding 5) Bonding internal surfaces with 6) Application of NX3 to internal OptiBond Solo Plus surfaces of inlay 7) Application of NX3 to internal 9) Clinically finished inlay 10) Postoperative view surfaces of preparation Your practice is our inspiration.™ All you need is Kerr When to use our cements
Guide to Cementation Self Etch no etch needed OptiBond All•In•One no etch needed Self Adhesive no bonding agent needed OptiBond Solo Plus etch needed Self Cure/ Light cure Self Cure/ Light cure Zirconium /
All Ceramic
• Not recommended
NX3. to be used when.
Maxcem Elite. to be used when.
Clinician prefers more traditional procedure Clinician prefers fast, easy, one step of etch & bond and/or preference for veneer procedure. No etching or bonding luting systems specifically for esthetics procedure is desired Clinician prefers automix tips; insuring even mix ofbase and catalyst, facilitates cement placement inprosthesis, on tooth structure, in root canal for posts Clinician prefers automix tips; insuring evenmix of base and catalyst, facilitates cementplacement in prosthesis, on tooth structure,in root canal for posts Existing preps are minimally retentive,requiring maximum bond strength Existing preps have adequate to Veneer cases when time, placement and light maximum retention cure are critical. Dentist has time for a longercementation procedure The seating of prosthesis will be Polymerization method can be chemical self cure and/ or light cure Suggested bonding agents OptiBond Polymerization method can be Solo Plus or OptiBond All in One chemical self cureChemical self cure will begin after mixing Your practice is our inspiration.™ All you need is Kerr Guide to Cementation Dr. Montri Chantaramungkorn, DDS
Dr. Isaac Novak, Bsc, DDS
Is a successful full-time private practitioner specializing in Comprehensive Restorative and Is a 1974 graduate of Western Ontario University in London Ontario. For the majority of Cosmetic Dentistry in Chiangmai, Thailand. He has been teaching Esthetic Dentistry at his 36 years in practice he has had a special interest in aesthetic full mouth reconstruc- Chiangmai University since 1985 and was the Chairman of Department of Restorative tion. Dr. Novak enjoys a rewarding career as the senior practitioner in his family practice in Dentistry at Chiangmai University from 1993 to 2002. He is also a Diplomate of the Thai Mississauga, Ontario, Canada. He is an active consultant for several dental manufactur- Board of Operative Dentistry and enjoys giving lectures on current materials and tech- ers, has authored articles, and continues to lecture on aesthetic rehabilitation, as well as niques on newly developed material in Restorative Dentistry.
new product development. He is a member of American Academy of Cosmetic Dentistry,Ontario Dental Association, Halton Peel Dental Association and serves as dental advisorto Alternative Dental Laboratories. In his free time Dr. Novak enjoys skiing, hockey, golf,and photography.
Prof. Francesco Mangani, MD, DDS
Prof. Mangani is a graduate of Medicine and General Surgery and he received his Post Graduate Certificate in Odontostomatology. He is Associate Professor at the Faculty of Medicine andSurgery and Chair of Restorative Dentistry at School of Dentistry Tor Vergata University Rome. Dr. Stephen Poss
He is also Chair of Dental Aesthetics, School of Dental Hygienist, Tor Vergata University Rome Dr. Stephen Poss is a graduate of the University of Tennessee and maintains an aesthetic and Head of the Aggregate Functional Area of Restorative Aesthetic Dentistry, Tor Vergata based practice in Brentwood, Tennessee. Dr. Poss has directed numerous live patient University Clinical Hospital Rome.
continuums at various teaching institutes emphasizing anterior and posterior aesthetic He is an active member of Italian Academy of Conservative Dentistry, Italian Academy of dentistry since 1995. Dr. Poss is presently the Clinical Director at The Center for Aesthetic Dentistry, Italian Society of Endodontics, Italian Society of Conservative Dentistry.
Exceptional Practices in Cleveland, Ohio. He is also on the editorial team of Reality He has authored over 180 scientific publications and more than 50 abstracts from research sessions concerning conservative dentistry and endodontics.
Dr. Poss lectures internationally on esthetic dentistry and TMD. He is an active consultant He has also authored 5 books of Restorative Dentistry.
to several dental manufacturers in the area of new product development and refinement.
He has had numerous articles published in the leading dental journals. He maintains acosmetic oriented restorative practice in Brentwood, Tennessee.
Dr. Ara Nazarian
Ara Nazarian, DDS is a graduate of the University of Detroit-Mercy School of Dentistry.
Upon graduation, he completed an AEGD residency in San Diego, California with the Dr. Joseph Sabbagh
United States Navy. Currently, he maintains a private practice in Troy, Michigan with anemphasis in comprehensive and restorative care. In 2002, he received the Excellence in Dr. Joseph Sabbagh graduated from the Saint-Joseph University (Beirut) in 1996 and in Dentistry Award and Scholarship. His articles have been published in various professional 2000 he obtained a Master in Operative Dentistry (Restorative Dentistry and Endodontics) dental journals including: Contemporary Esthetics, Dental Equipment and Materials, Dental from the Catholic University of Louvain (Belgium). He also obtained two certificates of Products Report, Dentistry Today and Dentaltown Magazine.
Advanced Studies in Biomaterials and Operative Dentistry from the University of Paris-VII Dr. Nazarian also serves as a clinical consultant for the Dental Advisor, testing new prod- (France) in 1997 and 1998.
ucts on the market. He is a member of the Academy of General Dentistry and the In 2004, he obtained his PhD in Biomaterials from the Catholic University of Louvain. American Academy of Cosmetic Dentistry and is a Fellow with the International Congress He has published many papers in the dental literature and has lectured locally and of Oral Implantologists.
internationally. He is fellow of the International College of Dentists, a member of theLebanese Dental Association and member of the Academy of Operative Dentistry.
- Assistant Professor in the department of Conservative and Aesthetic Dentistry in the Lebanese University, Lebanon.
- Senior Lecturer in Operative and Cosmetic Dentistry in the "Dental College" (a Lebanese private college for dental continuing education) Beirut, Lebanon.
Product Manager Prosthetics - Fellow researcher in the Catholic University of Louvain (Cribio division), Belgium.
- Private practices in Beirut and Brussels specialized in Cosmetic Dentistry and Marika received her Certified Dental Assistant Diploma from George Brown College inToronto Canada in 1984 & 2003 from University of British Columbia in Orthodontics.
Marika has had a long career in clinical dentistry. She now works as product manager forEurope managing products in the cements and impression material lines.
2010 KerrHawe SA KerrHawe SA Via Strecce 4 P.O.Box 268 CH-6934 Bioggio Phone ++41 91 610 05 05 Fax ++41 91 610 05 14 www.KerrHawe.com KerrHawe SA Via Strecce 4 P.O.Box 268 CH-6934 Bioggio Phone ++41 91 610 05 05 Fax ++41 91 610 05 14 www.KerrHawe.com

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