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Operative Dentistry

Adhesives, Cements and Intraoral Repair

(Last updated: August 18, 2014)

ADHESIVE for direct bonding to enamel and dentin

Ultra-Etch 35% phosphoric acid (Ultradent) - Stocked

Optibond FL (Kerr)  - Stocked

  1. adhesiveApply 35% phosphoric acid to enamel first, and then to dentin making sure that the etchant remains on dentin for LESS than 15 seconds. Rinse thoroughly for 15 seconds. Completely remove excess moisture from operating field, then from preparation with cotton pellet, sponget or microbrush. Dentin surface should appear slightly moist.
  2. Apply Primer (#1) with microbrush for 30 sec with continuous gentle agitation. Replenish primer as needed.
  3. Initially air dry primer gently, and then finish with moderate air pressure to evaporate all solvents. The dried surface should present a shiny, evenly primed appearance.
  4. Apply Adhesive (#2) with an applicator brush or microbrush to spread evenly, removing excess to avoiding pooling or marginal buildup. Do not use air syringe to disperse adhesive.
  5. Light cure for 30 sec. (18 J)
  6. Apply resin-based composite.

 

ADHESIVE for indirect bonding of "ceramic" restorations

All Bond TE Adhesive and ACE dispenser (Bisco)

bond te adhesive and ace dispenser

 

 

 

 

 

 

Tooth Surface Treatment

  1. After isolating adjacent teeth (clear matrix strips) apply 35% phosphoric acid to enamel first, and then to dentin making sure that the etchant remains on dentin for LESS than 15 seconds. Rinse thoroughly for 15 seconds. Completely remove excess moisture from operating field, then from preparation with cotton pellet, sponget or microbrush. Dentin surface should appear slightly moist.
  2. Dispense ALL-Bond TE using the ACE dispenser into a dap pen dish, mix with an applicator for 5 sec.
  3. Again, protecting/isolating adjacent teeth (clean and dry clear matrix strips), apply 1-2 coats onto the entire tooth preparation with a light agitating motion for 5-10 seconds.
  4. Gently air dry until there is no visible movement of the material. Then dry thoroughly for a minimum of 10 sec. The surface should appear shiny; otherwise, apply additional coats of ALL-BOND TE and repeat.
  5. Light cure each surface for 10 sec at 500mW/cm2. (Optional when using Duo-Link from Bisco)
  6. Apply Duo-Link resin cement to the internal surface of the restoration directly from the syringe.
  7. Seat each restoration with gentle, passive pressure.
  8. Remove excess cement immediately with a brush or instrument.
  9. Light cure each surface of the restoration for 40 seconds
  10. Check occlusion.
  11. Clean up excess and polish margins if necessary with resin composites polishers. Porcelain surfaces should be adjusted and polished with ceramic polishers.
  12. Optional: Clean surface/margins and apply surface sealant and light cure

Directions for use: http://www.bisco.com/instructions/IN-187R1_English.pdf 

 

Adhesive resin cementation guides for ‘ceramic’ restorations
(Dr. Marcos A. Vargas - Department of Family Dentistry)

 

Ceramic Restorations Classification

 

feldspathic flowchart
Printable Feldspathic flowchart

 

emax flowchart
Printable e.max flowchart

 

polycrystalline flowchart
Printable polycrystalline flowchart

Note: If not previously silanated by lab, confirm restoration fit on model, clean restoration and apply silane in advance of patient visit.  Silane bond  "maturation" has been shown to improve bonding to ceramic. Silane will not subsequently be removed by ultrasonic cleaning in alcohol or phosphoric acid cleaning after patient try-in.

Lava Ultimate Restorative for chairside CAD/CAM

  1. Complete try-in, adjustment, finishing and polishing steps
  2. Air abrade with aluminum oxide less than or equal to 50 micron at two bars (30 psi) until entire bonding surface has a matte appearance
  3. Clean with alcohol and dry thoroughly
  4. Apply silane (Bis Silane A  & B - Bisco)
  5. Apply adhesive (All Bond TE adhesive - Bisco)
  6. Apply cement and seat (Duo-Link - Bisco)

Luting and Resin Cements

 

Calibra (Dentsply/Caulk) – clinic approved, available in OPER

  • Base shades (3): translucent; opaque; light;
  • Catalyst (1): High viscosity
  • Description: light and dual-cured resin composite primarily used for cementation of resin composite or ceramic veneers, inlays/onlays
  • Directions for use: http://www.calibracement.com/sites/default/files/calibra-directions-for-use.pdf  Follow adhesive resin system instructions for bonding to tooth and Calibra instructions for luting the indirect restoration. If cementing veneer that is not excessively thick or opaque, use light cured base shade only. Simplifies luting procedure.

calibra

DUO-LINK (Bisco) – clinic approved, available in OPER

  • Description: DUO-LINK is a dual-cured luting cement with ultrafine filler particles and is intended to be used with an adhesive system. Available in a universal TRANSLUCENT shade, the exceptionally high glass filler content increases strength making DUO-LINK resistant to wear and staining. It is ideal for cementing all-ceramic/porcelain, metal, and composite restorations (inlays, onlays, crowns, bridges), as well as fiber and metal posts.
  • Instructions for use: See manufacturer’s instructions.
    • Working time: ≥ 2 min
    • Setting time: ≤ 5 min 30 sec
    • Light cure each surface of the restoration for 40 sec (24 J)
  • Directions for use: http://www.bisco.com/instructions/IN-027R6_English.pdf
luting agents

Panavia 21 (Kuraray) – clinic approved, available in OPER

  • Description: Opaque shade of self-cured resin composite primarily for cementation of posts and resin-bonded FPDs
  • Instructions for use: See manufacturer’s instructions. Use with supplied self-etch adhesive system (ED Primers).
  • Directions for use: http://www.kuraraydental.com/product/cements/panavia-21

panavia

FujiCem 2 (GC America) – clinic approved, available in OPER

fujicem

Flecks Cement (Mizzy) - stocked

  • Description: Zinc Phosphate cement for crown and bridge cementation.
flecks cement

Luting Recommendations Table

  Adhesive resin cement RMGI GI Zinc phosphate
Resin-based Composite (RBC) XXX      
"glassy" ceramics XXX      
Lithium disilicate XXX X    
Glass-infiltrated Alumina/zirconia X XXX X X
Alumina X XXX X X
Zirconium X XXX X X
Titanium X XXX X X
Noble metal X XXX X X
Base metal X XXX X X
Maryland Bridge XXX      

 

Intraoral Repair Kit (Bisco)

Clinic Approved - Available in Oper

intraoral repair kit

 

intraoral repair kit

Chair side AIR ABRASION (NOT involving enamel or dentin)

  • chair side abrasionCoJet Silicate Ceramic Surface Treatment System (3M ESPE)
    • Description: High-purity aluminum oxide 30 μm, modified with silica (SiO2). Embeds a ceramic layer on the surface of metal, porcelain or previously cured composite, producing/enabling silane coupling with composite by a chemical bond.
    • chair side abrasionApplications: Intraoral repair of fractured composite or porcelain, even with exposed metal. Extra oral pre-treatment of inlays/onlays, veneers, crowns and bridges, and pins and posts for adhesive luting. Rocatec lab system is also marketed for extra oral surface preparation.

 

 

Chair side AIR ABRASION(when enamel and/or dentin is involved)

Alumina 50 micron (Ivoclar Vivadent) chair side abrasion

  • Description: Alumina (Al2O3) air abrasive.
  • Applications: Use when CoJet silicate abrasive is indicated but enamel and dentin is also to be bonded. CoJet interferes with bond to tooth structure.

 

 

 

 

Porcelain etchant: Buffered hydrofluoric acid gel (Bisco)

clinic approved – available in OPER

  • Indications:acid gel
    • intraoral repair
    • preparing restorative material surface for luting
  • HF porcelain etchant improves the adhesive bond between porcelain and RBC/cement by increasing the surface area of the porcelain to be bonded.
  • HF porcelain etchant is available in 2 concentrations: 9.5% - reduce etching time during intraoral repair 4% - during preparing restorative porcelain for luting
  • BARRIER GEL is placed where etching is not desired

 

SILANATING AGENT

Bis SILANE (Bisco)silane

  • Description: BIS-SILANE is a two-part silane coupling agent that is used to enhance adhesion between porcelain and composite resins. Based on clinical experience, it has been noted that the silane, as packaged in the one-bottle systems, tends to polymerize as it approaches the end of its shelf life. The two-bottle silane system offers a more stable system to ensure effective bonding to porcelain. Silane is a dual function monomer consisting of a silanol group that reacts with the porcelain surface, and a methacrylate group that co-polymerizes with the resin matrix of the composite. Silane coupling agents are known to enhance the wettability of glass substrates by composite resins, increase physical, mechanical and chemical bonding of composite to porcelain, and yield a greater resistance to water attack at the bonding interface.
  • Prior to applying BIS-SILANE, the porcelain surface must be etched with buffered hydrofluoric acid. This process allows porcelain to become not only highly porous, but also highly receptive to the silane by creating reactive hydroxyl groups on the surface of the porcelain.
  • Directions for use:
    • Mix the BIS-SILANE by dispensing one drop from each of the two bottles (Parts A & B) into a mixing well and stir. Brush on 1-2 coats (thin coats are sufficient) of BIS-SILANE to the internal surface of the etched porcelain restoration and wait for 30 seconds. Dry with (warm if available) air syringe. NOTE: Surface of the porcelain will look the same after BIS-SILANE application to the naked eye.
    • Continue with cementation procedures.