Hi. I’m Frank Spear. I want to welcome you
to this blog. You know, in previous sections we’ve spent a lot of time talking about
anterior temorarization all the way from the creation of the initial model for indirect
temporization, through carving, finishing, polishing, etc.
What we haven’t talked about is temporary cementation. What I’d like to do in this
series is actually talk to you about temporary cements, both for anterior and posterior restorations.
When you think about temporary cements, there’s certain criteria we want. Obviously we want
them retentive, but we still want to be able to remove them. We also want it easy to clean
up at the time you place the temporary but also easy to clean up at the time you remove
the temporary. We want it to have a positive impact on the
pulp and the soft tissue. We want it to not interfere with bonding procedures. And we
also want to think about esthetics, because different temporary cements have different
colors and opacities, and they can show through our temporary restorations.
To give you an idea of why there may be some confusion about temporary cements, I just
looked online today, uh at Patterson Dental and typed in temporary cementation or temporary
cements. And there’s actually 429 different temporary cements online at Patterson Dental.
No wonder people kind of can’t figure out what to do.
What that tells you is there’s a lot of different temporary cements that work. So
I’m going to kind of limit this segment to just what I use, um, and why I use it.
Because, there’s certainly other ways of doing it besides the way I do it.
When I look at the categories – if you really were to narrow down temporary cements – you
kind of have ZOE, non-eugenol, resin, polycarboxylate and glass ionomer. I’m gonna leave out polycarboxylate
and glass ionomer. I know some people love them but to me they’re too hard to clean
off the tooth because they like to stick to the tooth.
So, in my world I live with the ZOE, non-eugenol, or resin cement. What I would consider to
be the traditional family would be the eugenol containing products like Temp-Bond. Uh, these
days you can get much easier mixing if you buy things like the Embonte from Dux Dental
which comes in a nice syringe. But it’s a very traditional zinc oxide eugenol cement.
And to me, there are certain advantages to that. Eugenol has some very favorable characteristics
especially in terms of it’s palliative nature towards the pulp, it’s seal and it’s antibacterial
nature. So, I happen to like eugenol-containing cements.
On the non-eugenol side, products like Zone are very very popular. Again it’s a simple
mixing system. Umm, very retentive but doesn’t have the eugenol in it.
And then we also have the resin temporary cements. Products like Neo-Temp is a water
pick product, or Tempon Clear which is, uh, another concept of a resin temporary cement
that’s a dual-cure product. Now, the challenge I have with resin temporary
cements is quite simple, and that is they leak. If they’re not bonded they leak. And
the challenge of having a leaking temporary is, if any of you have done it – you know
you can get tooth sensitivity, which is very problematic.
But you also can get black bacteria growing underneath it. So your patient comes back
with this nice black band around the gingiva where bacteria are growing underneath the
temporary. Now, I use resin temporary cements, and especially
use them on veneers, um, or for some cases non-retentive onlay preps. But other than
veneers and non-retentive areas I don’t use resin temporary cements. I usually use
traditional cements for full crowns, or onlays or inlays.
When I use a resin temporary cement, I always use it with Gluma. And Gluma is a great disinfectant
and a great desensitizer. And so, whenever I’m using resin temporary cement, I’m
gonna show you a video in a second of how I use it, but the Gluma will keep that black
bacteria from growing underneath. It will also in fact, also keep the tooth
from being sensitive. So here’s a set of veneer temporaries. We’re trying them on
to make sure the fit is correct before we actually place them. And they were made very
much like the series that you seen, uh, the segment over the last eight weeks or so, with
just all the indirect temporization. I typically spot edge all of my veneer restorations.
So, small dot of Etchon on the enamel. Rinse the Etchon off. And now I’m gonna take an
applicator and I’m gonna apply the Gluma. And we don’t want the Gluma running all
over the mucosa. We don’t want it on tissue cause it is glutaraldehyde in there.
It’s a little foam applicator. And this is Gluma desensitizer. This isn’t Gluma
bonding agent. This is just the Gluma desensitizer. It’s glutaraldehyde and hema. And now, I
don’t need to actually place any bonding agent because the temporary cement will stick
to the edgary just fine. And now, I seek the temporary to place. Now,
this temporary, this patient wanted very white teeth. And so I’m using Neotemporary cement.
And I let it get to a rubbery phase before I try and clean it up. And then I just go
ahead and start to pick at it, once it finally gets to that rubbery phase.
I certainly don’t want it to go all the way cured before I start cleaning it. It’s
too much work. My most common temporary cement today for veneer temporaries – unless I would
really want to brighten them significantly- in which case a product like Neo temp works
well. But my most common resin cement is what you
just saw, in terms of Etch and Gluma. But then I use one of my light-cure resin cements
out of my resin cementation kit. I happen to use the 3M Reliax product. But I pick one
of the colors I don’t use very often. And I actually use that to put my temporaries
on for my veneers. Now, what do I personally use for full crown
temporaries? Well, for pretty much thirty years my typical temporary cement for full
crowns has been Caulk Final, for inlays, for retentive onlays, for full crowns. It reinforces
the OE cement much like IRM is. Great properties in terms of temporaries don’t come loose.
Umm, the temporaries, the teeth are almost never sensitive underneath it because of the
Eugenol contained within it. And let’s talk about eugenol and bonding,
because I do a lot of bonded restorations on my full crowns. Free eugenol is what inhibits
polymerization of cements. It’s the free eugenol itself. Free eugenol is what inhibits
the polymerization of our temporary cements. And what we know from research is that in
fact, the diffusion of eugenol from ZOE cement peaks at one day after you cement the temporaries.
And it’s essentially down to zero by fourteen days. What that means is, if you’ve temporaries
on there for 14 days, there’s basically no free eugenol left.
And in fact, if you look – and I’m giving you an article on the right, just for a reference
for the eugenol diffusion – but if you actually look in the literature for articles about
the interference of ZOE on bonding when compared to non-eugenol cements.
Here’s at least four references and there’s actually more than that, that will show you
there’s no difference whatsoever between eugenol-containing and non eugenol-containing
cements as far as bonding, as long as the temporaries’ in place at least 7 days.
Now, the truth is, eugenol and non-eugenol containing cements interfere with bonding.
They both do. But it’s not because of the eugenol. It’s because of the contamination
of the temporary cement on the tooth. So what we do know is when you want to bond,
you have to clean the tooth. And, air abrasion is one option that’s been well-researched.
Other options are rubber cup with pumison water, and excavation with metal instruments.
And, in fact all of them seem to prove very effective.
And here’s some references for you, if you would like to in fact research air abrasion.
Basically what it says is, whether you use eugenol-containing cement or a non eugenol-containing
cement, if you air-abrade the tooth and then apply your dentin adhesive, you get the same
bond as if you would have applied the adhesive immediately upon prepping the dentin.
So, just to show you a little video of cementing using Caulk Final, we’ll put this upper
arch and with Caulk Final, the biggest thing I want you to watch is actually how little
cement expresses when it’s seated. We paint with a brush Vaseline on the outside
of the temporary, but then when we load the temporary cement, we load the temporary with
a paintbrush. Just painting the cement up the walls of the temporary.
So here’s the anterior temporary that we’re gonna be cementing. We check and make sure
that it fits well first. And so, we’ll play this video. Putting all the segments in – it’s
three different pieces – making sure everything fits correctly.
And then when we load the temporary, as I said we’ll paint Vaseline on the outside
of it, and then we’ll paint the eugenol inside with the brush. I don’t wanna fill
it up, I don’t need all of that. And so, we’re gonna take the segments off,
and watch how little cement expresses. Now, the beauty of ZOE is you can let it harden
completely, and then it’s easy to chip off. But if you load it too full, it goes everywhere,
and then you’re picking it off the gingiva, and you’re trying to bite it in terms of
the big chunks around the anterior teeth. And so, that’s a very typical cementation
for me using Caulk Final. And then you go in. You can clean it off with your super floss
in the areas of the posterior, and explore in the interior segments once it’s hard.
Super simple cement to clean up. And here’s what it looks like once the temporary’s
completed and clean. So in our office, we essentially do use Caulk
Final for almost all of our traditional cementation, for the reasons I mentioned. And then we use
the resin cements – typically our light-cured resin cement from our veneer kit, as our typical
resin cement for our veneers and bonded onlay. Now, what we haven’t talked about in this
one is how do you get everything back off, and so in future segments that’s what we’ll
be talking about is, how do we get our temporaries back off once they’ve been placed.
Enjoyed sharing this with you. I look forward to seeing you soon.