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Clinical Study of Dental Cements. VI. a Study of Zinc Phosphate, EBA-Reinforced Zinc Oxide Eugenol and Polyacrylic Acid Cements As Luting Agents in Fixed Prostheses

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Clinical Study of Dental Cements. VI. a Study of Zinc Phosphate, EBA-Reinforced Zinc Oxide Eugenol and Polyacrylic Acid Cements As Luting Agents in Fixed Prostheses Clinical Study of Dental Cements. VI. A Study of Zinc Phosphate, EBA-Reinforced Zinc Oxide Eugenol and Polyacrylic Acid Cements as Luting Agents in Fixed Prostheses RALPH G. SILVEY and GEORGE E. MYERS Crown and Bridge Department, School of Dentistry, University of Michigan, Ann Arbor, Michigan 48109, USA Three cements were used to cement single res- second, willingness to participate in the study. torations and bridges. Patients were recalled Patient selection on these criteria gave a sam- and evaluated for satisfactory retention of the ple of the greatest variety of restorative prob- restorations. Results obtained for a zinc phos- lems and as close as possible to those met in the phate cement, a reinforced zinc oxide eugenol general practice of dentistry. cement and a polyacrylic acid cement are pre- To achieve an approximately equal dis- sented. tribution of each of the cements, they were as- signed on a rotation basis as the cases were com- J Dent Res 56(10) :1215-1218 October 1977. pleted and ready for cementation. Occasion- A previous report' gave data on the clinical use ally the rotation sequence was changed to select as a luting agent of a zinc prosphate and a a cement more suitable for a particular case. methyl methacrylate reinforced zinc oxide This alteration was always in response to den- eugenol cement. This study compares, during tin pulp considerations and was never based on a three-year period, a zinc phosphate cement,* retentive factors or operator preference. A rou- a zinc oxide and eugenol cement reinforced tine cementation procedure was used for the with ethoxybenzoic acid and aluminat and a cementation of all cases as follows: polyacrylic acid cement: as luting agents for 1. The cement was assigned. bridges and single crown restorations. 2. The abutment teeth were isolated with cotton rolls and a saliva ejector and Materials and Methods dried with a stream of warm air. 3. If zinc phosphate cement was to be Tenacin was selected because it is the zinc used, two thin coats of varnish§ were phosphate routinely used in the School of Den- applied to the abutments. If Zebacem tistry. Representative cements of the poly- or P.C.A. was used, the abutments were acrylic acid and EBA reinforced zinc oxide and left unvarnished. eugenol types were selected and tested for film 4. To eliminate variables in cement ma- thickness, consistency, compressive strength, nipulation, one of the two principal and working time. One cement of each type investigators mixed the cement accord- was selected for optimal qualities in the cate- ding to the manufacturer's directions gories tested. and applied it to the bridge retainers. Patients for the study were selected in the 5. If a retainer with pins was involved, ce- Undergraduate Clinic of the School of Den- ment was placed in the pinholes in the tistry, The University of Michigan. The criteria abutment tooth using a Lentulo spiral. applied were, first availability of the patient for 6. The prosthesis was passed to the dental periodic recalls over the course of the study and student treating the case to carry out the remainder of the cementation Received for publication June 25, 1976. Accepted for publication January 7, 1977. under close supervision of the investi- This study was supported by NIH Grant No. 5R01- gator. DE-02593-03. * Tenacin, L. D. Caulk, Milford, De. 7. The prosthesis was seated with biting t Zebacem, L. D. Caulk. force applied through an orangewood : P.C.A., S.S. White, Div of Pennwalt, Philadel- phia, Pa. stick placed on the occlusal surface of § Copalite. H. Bosworth Company, Chicago, IL. the restoration. 1215 1216 SILVEY & MYERS j Dent Res October 1977 TABLE 1 face. If any leakage was noted (fluid escaping the tooth interface), the retainer was DISTRIBUTION OF THE CEMENTS from gold recorded as loose. If no fluid movement was de- tected, then the retainer was recorded as sealed. Single Cement Restorations Bridges Total Crowns were tested in the same manner except that the B scaler was placed in the in- 57 195 252 Zinc Oxide Eugenol of the crown and en- Polyacrylic Acid 47 193 240 terproximal concavity Zinc Phosphate 58 159 217 gaged in the gold to place an occlusally directed Total 162 547 709 force on the restoration. Results 8. While the patient maintained a con- Four hundred and forty one patients par- stant pressure with the orangewood ticipated in the study. Seven hundred and nine stick the operator completed the mar- cementations of single restorations and bridges of the restorations. ginal adaptation were completed. 9. A cotton roll was placed on the occlu- The distribution of the three cements sal surface of the restoration and the among the 441 patients was 121 cementations patient was instructed to maintain with the zinc oxide and eugenol cement, 98 pressure on the restoration until the with polyacrylic acid cement, and 98 with zinc elapse ten the start of of minutes from phosphate cement. One hundred and twenty the mix. four patients had restorations cemented with 10. The excess ccPnsent was cleaned from more than one of the cements. th e gingival crevice and the patient Five hundred and forty seven bridges and dismissed. 162 single restorations were cemented. The dis- Patients were recalled at six-month inter- tribution of the cements is shown in Table 1. vals for the duration of the study. They were The bridges in the study varied in length from return if any unusual instructed to immediately 2-unit to 10-unit restorations. The highest single or symptoms developed. signs group of bridges was the 3-unit bridge of which At t'-e recall appointment, the bridge was there were 385. Details of other bridges are inspected clinically for looseness, recurrent mar- listed in Table 2. and occlusal harmony. To inspect ginal decay, Of the 441 patients in the study, 222 were the restorations for looseness, the quadrant of recalled two or more times, 160 were recalled the mouth where the bridge was located was once, and 59 were not available for recall. isolated with cotton rolls and saliva ejector and The success rate of cementation of single warm A "B"* scaler was placed dried with air. restorations is shown in Table 3. The success interproximally under a connector and an oc- rate of cementation of all bridges is shown in clusally directed force was applied to the Table 4. The failure of one retainer of a bridge bridge. The operator checked visually for is recorded as a bridge failure. Since a bridge movement and the patient was questioned as to usually involves two or more retainers no recog- whether any movement or unpleasant sensation nition is given to the other successful retainers. was detectable. With the area still isolated, the we are concerned with the success of the ce- patient put biting pressure on the bridge with As is more an orangewood stick placed on its occlusal sur- ment in securing retainers, it meaning- ful to examine bridge success by recording re- * Pennwalt S.S. White, Philadelphia, Pa. tainers individually. The success rate for bridge TABLE 2 LENGTH OF BRIDGES AND DISTRIBUTION OF CEMENTS 2-Unit Bridge 3-Unit 4-Unit 5-Unit 6-Unit 7-Unit 8-Unit 10-Unit Total Zinc Oxide Eugenol 3 139 29 12 7 1 3 1 195 Polyacrylic Acid 7 128 36 13 7 1 1 0 193 Zinc Phosphate 3 118 28 6 3 0 1 0 159 Total 1 3 385 93 31 17 2 5 1 547 Vol. 56 No. 10 DENTAL CEMENTS AS LUTING AGENTS 1217 TABLE 3 TABLE 5 SUCCESS RATE ALL SINGLE RESTORATIONS SUCCESS RATE BRIDGE RETAINERS Total Success Percent Total Success Percent All Three Cements 162 159 98.1 All Three Cements 1082 1049 96.9 Zinc Oxide Eugenol 57 56 98.2 Zinc Oxide 383 368 96.1 Polyacrylic Acid 47 45 95.7 Polyacrylic Acid 388 374 96.4 Zinc Phosphate 58 58 100 Zinc Phosphate 311 307 98.7 servation was 6 months and the maximum retainers recorded individually is shown on Table 5. about 30 months. was on of span The time interval from cementation to No limit placed the length or the location of restorations for inclusion in failure was recorded. Tables 6, 7 and 8 sum- marize the failures for the polyacrylic acid, zinc this study. Restorations listed as 2-unit bridges are almost exclusively splints placed in prepara- oxide eugenol, and zinc phosphate cement re- tion for a clasp type partial denture. The pre- spectively. In the case of polyacrylic acid, of a total of eleven failures, 5 occurred in 6 months ponderance of 3-unit bridges (385) in the sam- ple reflects the most common type of case done or less, 4 between 6 and 12 months, and 2 be- Crown and tween 12 and 20 months. Of 16 failures with the in the Undergraduate Bridge Clinic. A fair number of 4- to 6-unit zinc oxide eugenol cement, 1 failure occurred (141) bridges are present in the sample. Bridges span- in less than 6 months, 13 failures occurred be- ning more than 6 units are rarely done in the tween 6 and 12 months, and 2 failures between 12 and 25 months. Of the three failures with Undergraduate Clinic. zinc phosphate all occurred in the first 6 Although the cementing media were as- months. signed on a rotation basis the total welfare of the patient had to be considered. If the patient A variety of restorations was used as had a history of hypersensitive teeth or if pins bridge retainers in this study including com- had to be placed for retentive purposes and they plete crowns, three quarter crowns, M.O.D.
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