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Point of Care the “Point of Care” Section Answers Everyday Clinical Questions by Providing Practical Information That Aims to Be Useful at the Point of Patient Care

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Point of Care the “Point of Care” Section Answers Everyday Clinical Questions by Providing Practical Information That Aims to Be Useful at the Point of Patient Care Point of Care The “Point of Care” section answers everyday clinical questions by providing practical information that aims to be useful at the point of patient care. The responses reflect the opinions of the contributors and do not purport to set forth standards of care or clinical practice guidelines. Readers are encouraged to do more reading on the topics covered. If you would like to contribute to this section, contact editor-in-chief Dr. John O’Keefe at [email protected]. Q U E S T I O N 1 How can I limit the number of different dental cements available in my dental practice and still be able to address all prosthetic clinical situations? Background cements currently being used in our prosthodontic s a clinician’s repertoire expands to include group practice (Table 1). various indirect restorations, there is a ten- Adency to accumulate a large number of dif- �hoice of Dental Cements ferent dental cements in the office. As prosthetic Conventional Fixed Prosthodontics materials each demand specific luting agents, Provisional restorations can be cemented with logistic headaches arise for both the dentist and calcium hydroxide (Dycal, Dentsply International, staff. Regrettably, the “universal” dental cement is York, Penn.), as this material is easy to manipulate, still elusive. readily available and does not interfere with or Several types of dental cement are available, compromise the integrity of the permanent ce- each possessing unique properties and handling ment. One generally places it on the margins of an characteristics; no one product is ideal for every interim restoration, then seats the restoration. The type of restoration. A dental cement should act as crown should not be filled with cement as this can a barrier against microbiological leakage, holding lead to difficulties when trying to remove it. This the tooth and restoration together through some cement sets rapidly and excess cement is easily form of attachment (mechanical, chemical or a cleaned up. combination) and sealing the interface between Three other cements are required to ad- 1 them. Manipulation of any cement is important, dress all aspects of fixed prosthodontics. C&B as variations in the powder-to-liquid ratio can Metabond (Parkell, Edgewood, N.Y.) is the cement significantly influence working and setting time, of choice for nonprecious metals, such as resin- consistency and flow and the degree of solubility, bonded bridges and bonded posts in endodontic- 2 strength and film thickness of the cement. In this ally treated teeth. This cement is formulated with article, I discuss and justify the choice of dental methyl methacrylate monomer and acrylic resin filler and is catalyzed by tributyl-borane. It bonds Table 1 Cements used for different types of restorations to enamel, dentin and metal. The use of a C-R Type of restoration �ental cement syringe (Centrix, Shelton, Conn.) reduces voids in the cement and allows the clinician to con- Conventional fixed prosthodontics trol the placement of the cement with great ease Provisional restoration Dycal (Figs. 1–3). This adhesive cement is invaluable for Cast post and core C&B Metabond patients who present with fractured porcelain and Resin-bonded bridge C&B Metabond exposed metal on a porcelain-fused-to-metal res- toration. Masking the exposed metal with opaque Metal inlay/onlay/full gold crown Maxcem C&B Metabond provides an excellent esthetic re- Porcelain inlay/onlay/crown sult when a porcelain repair is indicated. Porcelain-fused-to-metal restoration Maxcem A dental cement that is proving to be a work- Porcelain veneers Nexus 3 horse for most indirect restorations is Maxcem Implant-supported prostheses (Kerr Corp., Orange, Calif.). This self-etching, self-adhering cement is a dual-cure resin cement Alumina abutments Maxcem that is dispensed directly with an auto-mixing syr- Zirconia abutments Nexus 3 inge. Once the restoration is seated, excess material Titanium/gold alloy abutments Improv can be light cured for several seconds allowing for easy clean-up. It is indicated for all metal and ���JCDA • www.cda-adc.ca/jcda • October 2007, Vol. 73, No. 8 • 697 ––––––– Point of Care ––––– Figure 1: Mixing and loading C&B Metabond into a Centrix syringe tube. Figure 2: The C-R syringe. Figure 3: Expressing the cement for a cast Figure 4: Excess Improv cement for an post and core restoration. implant-supported porcelain-fused-to- metal restoration cemented on a gold alloy abutment. ceramic inlays, onlays and full coverage restorations. cements promises to streamline the inventory of Anecdotally, patients have not reported any pos- a dental practice, while allowing the clinician to toperative sensitivity when Maxcem has been used. continue to use both traditional and novel pros- The resin-luting cement Nexus 3 (Kerr) is ideal thetic materials. a for cementing porcelain veneers as it is available in a number of shades and viscosities. This cement THE AUTHOR can be light- or dual-cured. Dr. John P. Zarb is a prosthodontist with Implant-Supported Prostheses Prosthodontic Associates and a staff prosthodontist All ceramic implant-supported prostheses at the University of Toronto and Mount Sinai Hospital, cemented to zirconia abutments require a final Toronto, Ont. ����������������Email: [email protected]��������������m.. cement that is both strong and esthetic. In this The author has no declared financial interests in any company situation, either Maxcem or Nexus 3 can be used. manufacturing the types of products mentioned in this article. Improv (Nobel Biocare, Gothenburg, Sweden) is a References universal cement in implant prosthodontics that 1. Diaz-Arnold AM, Vargas MA,���������������������������������� Haselton DR. �����������������Current status of can be used for implant-supported prostheses in luting agents for fixed prosthodontics. ���������������J Prosthet Dent 1999; which porcelain-fused-to-metal restorations are 81(2):135–41. 2. Jones DW. Dental cements: an update. J Can Dent Assoc 1998; cemented to customized or prefabricated metal 64(8):569–70. (titanium, gold alloy) abutments (Fig. 4). As the technology of dental biomaterials con- Further Reading tinues to evolve, a universal dental cement may be- Powers JM. Cements. In: Craig RG, Powers JM, editors. Restorative come a reality. Until that time, this list of 5 dental dental materials. St. Louis: Mosby; 2002. p. 593–634. 698 ���JCDA • www.cda-adc.ca/jcda • October 2007, Vol. 73, No. 8 • ––––––– Point of Care ––––– Q U E S T I O N 2 How do I select an attachment for use in a removable partial denture or overdenture? Background Case 1 ypical considerations when selecting an at- The patient in case 1 wanted better retention tachment for a removable partial denture or and a more esthetic removable partial denture, and Toverdenture include the amount of interoc- the Bredent Vario-Kugel-Snap Sagitall (VKS-SG) clusal space available, the size and periodontal ball-and-socket stud-type attachment was selected. status of the abutment and the stress-breaking Figure 1 illustrates the use of 4 “mini” Bredent ability of the attachment. Other factors, such as VKS-SG attachments. Figures 2 and 3 illustrate retention, ease of use and anticipated lifespan of the removable partial denture in place. Because of the attachment, should also be considered, and the number of abutments and the patient’s dem- these factors are the focus of the discussion in this onstrated ability to insert and remove the partial article. The 2 most commonly used dental attach- denture easily, the yellow (regular-friction) matrix ments in our group prosthodontic practice are the was used. Bredent and Locator attachments. ttachment with an Overdenture ttachment with a Removable Partial The Locator attachment (manufactured by Zest �enture Anchors, Inc., Escondido, Calif.) is a commonly Bredent (Senden, Germany) manufactures a used attachment in our group prosthodontic prac- variety of styles of attachments suitable for use tice. It consists of a metal female component that in many applications. One of the main benefits is fixed intraorally and a nylon male component of the Bredent line of attachments is their reli- anchored in a metal housing in the denture base. ability of retention and their ease of use. The reten- It can be used either for tooth or implant applica- tive mechanism for these attachments is based on tions. Like the Bredent attachments, the nylon plastic female components (friction matrixes) that male retention elements of the Locator system sit in metal housings in the removable denture. are colour-coded according to degree of retention These friction matrixes are colour-coded: green for (blue = 1.5 lb/3.3kg, pink = 3 lb/6.6 kg, clear = reduced-friction retention, yellow for regular- 5 lb/11 kg). A green retention element is used friction retention and red for high-friction reten- for abutments of varying degrees of angulation tion. These plastic retentive components can easily (10° to 20° angle). Furthermore, the Locator has be removed and replaced at chairside by the dental a self-aligning design, whereby the male portion practitioner. A handful of the matrixes can be snaps into the female portion. Patients with this stocked at little cost and replaced as needed. The attachment find it very easy to insert and remove selection of a particular friction matrix depends on their dentures. the design of the prosthesis, the number of abut- Finally, the Locator has a very low profile, so is ments available and the patient’s manual dexterity. an ideal choice if interarch space is limited. Like Figure 1: Palatal view of the 4 mini Figure 2: Palatal view of the removable Figure 3: Frontal view of the removable Bredent Vario-Kugel-Snap attachments. partial denture retained with Bredent Vario- partial denture. Kugel-Snap attachments. ���JCDA • www.cda-adc.ca/jcda • October 2007, Vol. 73, No. 8 • 699 ––––––– Point of Care ––––– Figure 4: The Locator core tool.
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