• The Materials
• Isolation, Clean-out, Liners, Block-outs
• Inlays, Onlays and All Ceramic Crowns
• Impressions and Provisionals
• CAD/CAM vs Pressed materials
Topics
• Cementation / Bonding / Cements
• Occlusal Adjustment
Adhesive
Cementation
The Ideal Cement
• Flexible, not brittle • Longevity
• Able to create a long term seal • Low film thickness
• Color stable (esthetic)/Tertiary Amine Free • Inexpensive
• Multiple Color options • Reduces post-op sensitivity
• Appropriate opacity/translucency • Strong adhesion to tooth and restoration
• Low shrinkage • Easy to manipulate/few steps
• Technique friendly • Low solubility
• Radiopaque • Provides resistance and retention
• Biocompatible/HEMA free • Antibacterial
• Fluoride release/recharge • Anti-MMP
• Highly wettable • High modulus
• Versatility/Compatibility • Marginal seal
• Bioinductive/Bioregenerative • Tooth-like coefficient of thermal expansion
• Self Adhesive/Self Curing • Long shelf life
• Good working/setting times • Thermal insulator
• Chemical adhesion • Self silanating
THE FOUR OPTIONS FOR SEALING DENTIN
1. I D S ( i m m e d i ate d e nt i n s e a l i n g )
AT PREP 2 . D D S ( d e l aye d d e nt i n s e a l i n g )
3. P D S ( p re - c e m e ntat i o n d e nt i n
AT SEAT
sealing)
4. S D S ( s i m u l ta n e o u s d e nt i n s e a l i n g )
SEALING DENTIN
Technique Bond Strength Fit Temp Impressioning Risk of Post op
contamination sensitivity
IDS HIGH GOOD DIFFICULT TECH SENS LOW LOW
DDS HIGH FAIR DIFFICULT EASY LOW LOW
PDS MOD FAIR EASY EASY HIGH MOD
SDS MOD V. GOOD EASY EASY HIGH MOD
Immediate Dentin Sealing
For Ceramic
restorations, should
we bond the tooth
the day it is
prepped?
I m m e d i a t e D e n t i n S e a l i n g ( fo r a l l c e r a m i c r e s t o r a t i o n s )
Significantly improves bond strength for indirect porcelain restorations.
Up to 5x more bond strength!!! (Magne 2005)
Minimizes post-operative sensitivity.
I m m e d i a t e D e n t i n S e a l i n g ( fo r a l l c e r a m i c r e s t o r a t i o n s )
Significantly improves bond strength for indirect porcelain restorations.
Up to 5x more bond strength!!! (Magne 2005)
Minimizes post-operative sensitivity.
Involves bonding all exposed dentin at the preparation appointment.
- Total Etch or Self Etch
- Before or After the impression
- Requires a modified provisional restoration protocol
Immediate dentin sealing improves bond strength of indirect restorations
Pascal Magne, DMD, PhD,a Tae Hyung Kim, DDS,b Domenico Cascione, CDT,c
JPD 2005
and Terence E. Donovan, DDSd
Division of Primary Oral Health Care, University of Southern California, School of Dentistry,
Los Angeles, Calif
DDS = delayed dentin sealing (bonding at cementation)
IDS = immediate dentin sealing (bonding at prep)
JPD 2005
After IDS
Immediate Dentin Sealing before the
impression requires complete removal of
the oxygen inhibited layer.
Failure to do so, will result in unset
impression material (for PVS) and if
removed causes polyether to be bonded to
the tooth.
Removal by alcohol swab or
air-blocking + pumice.
IDS after impression requires careful
application of a very thin film-thickness
bonding agent (no filled adhesives!)
Immediate Dentin Sealing???
UCLA School of Dentistry has been
advocating IDS with Glass Ionomer Liners
before the term “IDS” even existed…
Immediate Dentin Sealing???
The key to success isn’t dentin bonding, it’s
ENAMEL BONDING
DENTIN BONDING IS TEMPORARY!
Immediate Dentin Sealing???
the peripheral ring of enamel allows for a
bond that lasts.
Adhesive Delivery
Sequence
• Recovery from milling chamber-
rinse or from lab
• Trial fit
• Finish and polish the restoration
• Prepare the restoration surface
• Isolation
• Prepare the tooth surface
• Application of luting agent
• Polymerization and finishing
Ceramic
Interface
Interface
Tooth
Ceramic Interface
Ceramic
Silane
Resin Cement
Bonding
Hybrid layer
Tooth
Tooth Interface
ADHESI R e s t o r a t i o n
Preparing
ON Etch
Intaglio
• Etch for 20 seconds
• Do not ”Over etch”
Ceramic Etching
HF acid dissolves the Silica matrix leaving the rough filler
HF acid creates pores in the ceramic
Lithium Disilicate
Milled Interface Feldspathic Porcelain
(IPS e.max)
60 seconds 20 seconds
Grab restoration with OptraStick (Ivoclar)
Etch intaglio
PLUS 0.5 mm
beyond margin
onto surface
ADHESI Preparing
Restoration
ON
Rinse
Dry
ADHESI R e s t o r a t i o n
Preparing
ON Bis-
P a r t Silane
•
•
2 Bottle system
Mix together
A/B • 1-2 coats
• 30 seconds
2 Bottle
ADHESI R e s t o r a t i o n
Preparing
ON
Lightly
Bis-
Dry Silane
Lightly sandblast preparation surfaces
Etching
Ready for
Etching
Insure Rubber
Dam Seal
Restoration
Surface Ready
Enamel etching beyond
2mm margin
2mm margin
Enamel etching beyond
Dentin etching
Dentin etching
ADHESI Preparing
To o t h
ON
R i n s e 2 0
sec
Suction to
Moist ETCHIN
Mix: 5 Bonding
Seconds
Apply 1-2
coats, 5-10
seconds
Gentle air
dry 5
seconds –
no visible
movement
Thoroughly
air dry 10 5 5-10 5 10
seconds MIX APPLY DRY DRY
