A bioactive dental luting cement--its retentive properties and 3-year clinical findings.

A clinical validation study was conducted to determine the performance of a new bioactive dental cement (Ceramir C&B, Doxa Dental AB) for permanent cementation. The cement is a new formulation class, which is a hybrid material comprised of calcium aluminate and glass-ionomer components. A total of 38 crowns and bridges were cemented in 17 patients; 31 of the abutment teeth were vital and seven were non-vital. Six restorations were bridges with a total of 14 abutment teeth (12 vital/ two non-vital). One fixed splint comprising two abutment teeth was also included. Preparation parameters were recorded, as well as cement characteristics such as working time, setting time, seating characteristics, and ease of cement removal. Baseline data were recorded for the handling of the cement, gingival inflammation, and pre-cementation sensitivity. Post-cementation parameters included post-cementation sensitivity, gingival tissue reaction, marginal integrity, and discoloration. All patients were seen for recall examinations at 30 days and 6 months. Fifteen of 17 subjects and 13 of 17 patients were also available for subsequent comprehensive 1- and 2-year recall examination, and 13 patients were available for a 3-year recall examination. Restorations available for the 3-year recall examination included 14 single-unit full-coverage crown restorations, four three-unit bridges comprising eight abutments, and one two-unit splint. Three-year recall data yielded no loss of retention, no secondary caries, no marginal discolorations, and no subjective sensitivity. All restorations rated excellent for marginal integrity. Average visual analogue scale (VAS) score for tooth sensitivity decreased from 7.63 mm at baseline to 0.44 mm at 6-month recall, 0.20 mm at 1-year recall, and 0.00 mm at 2- and 3-year recall. Average gingival index (GI) score for gingival inflammation decreased from 0.56 at baseline to 0.11 at 6-month recall, 0.16 at 1-year recall, 0.21 at 2-year recall, and 0.07 at 3-year recall. After periodic recalls up to 3 years, Ceramir C&B thus far has performed quite favorably as a luting agent for permanent cementation of permanent restorations. In-vitro crown-coping retention studies were also conducted using this cement and various control cementation materials. Mean laboratory retentive forces measured for Ceramir C&B were comparable to other currently available luting agents for both metal and all-ceramic indirect restorative materials.

Physical properties and comparative strength of a bioactive luting cement.

UNLABELLED: New dental cement formulations require testing to determine physical and mechanical laboratory properties. OBJECTIVES: To test an experimental calcium aluminate/glass-ionomer cement, Ceramir C and B (CC and B), regarding compressive strength (CS), film thickness (FT), net setting time (ST) and Vickers hardness. An additional test to evaluate potential dimensional change/expansion properties of this cement was also conducted. METHODS AND MATERIALS: CS was measured according to a slightly modified ISO 9917:2003 for the CC and B specimens. The samples were not clamped while being exposed to relative humidity of great than 90 percent at 37 degrees C for 10 minutes before being stored in phosphate-buffered saline at 37 degrees C. For the CS, four groups were tested: Group 1-CC and B; Group 2-RelyX Luting Cement; Group 3-Fuji Plus; and Group 4-RelyX Unicem. Samples from all groups were stored for 24 hours before testing. Only CCandB was tested for ST and FT according to ISO 9917:2003. The FT was tested 2 minutes after mixing. Vickers hardness was evaluated using the CSM Microhardness Indentation Tester using zinc phosphate cement as a comparison material. Expansion testing included evaluating potential cracks in feldspathic porcelain jacket crowns (PJCs). RESULTS: The mean and standard deviation after 24 hours were expressed in MPa: Group 1 equals 160 plus or equal to 27; Group 2 equals 96 plus or equal to 10; Group 3 equals 138 plus or equal to 15; Group 4 equals 157 plus or equal to 10. A single-factor ANOVA demonstrated statistically significant differences between the groups (P less than 0.001). Pair-wise statistical comparison demonstrated a statistically significant difference between Groups 1 and 2. No statistically significant differences were found between other groups. The FT was 16.8 plus or equal to 0.9 and the ST was 4.8 plus or equal to 0.1 min. Vickers hardness for Ceramir C and B was 68.3 plus or equal to 17.2 and was statistically significantly higher (P less than 0.05) than Fleck's Zinc Phosphate cement at Vickers hardness of 51.4 plus or equal to 10. There was no evidence of cracks due to radial expansion in PJCs by the Ceramir C and B cement. CONCLUSION: All luting cements tested demonstrated compressive strengths well in excess of the ISO requirement for water-based cements of no less than 50 MPa. Ceramir C and B showed significantly higher CS than RelyX Luting Cement after 24 hours, but was not significantly higher than either Fuji Plus or RelyX Unicem. The ST and FT values of CC and B conform to and are within the boundaries of the requirements of the standard. Surface hardness was statistically higher than and comparable to zinc phosphate cement. There was no evidence of potentially clinically significant and deleterious expansion behavior by this cement. All cements tested demonstrated acceptable strength properties. Within the limits of this study, Ceramir C and B is deemed to possess physical properties suitable for a dental luting cement.

Antibacterial properties of dental luting agents: potential to hinder the development of secondary caries.

A modified direct contact test was used to evaluate the antibacterial properties of four commercially available dental luting agents (RelyX Unicem, Ketac Cem, Ceramir Crown & Bridge and Harvard Cement) and two reference materials (glass-ionomer cement and calcium aluminate cement) compared to a negative-control material (PMMA). Streptococcus mutans bacteria were placed in direct contact with specimens that had been aged for 10 min, 1 day, and 7 days, in order to test the antibacterial properties of the materials. A metabolic assay containing resazurin was used to quantify the amount of viable bacteria remaining after the direct contact tests. The effects of pH and fluoride on bacteria proliferation were also evaluated. Strongest antibacterial properties were found for calcium aluminate cement, followed by Ceramir Crown & Bridge and RelyX Unicem. Ketac Cem, Harvard Cement, and the reference glass-ionomer cement showed bacteria content either higher than or not significantly different from the PMMA control in all instances. pH levels below 6.3 and above 9.0 were found to have negative effects on bacterial proliferation. No correlation between either acidic materials or fluoride release and antibacterial properties could be seen; rather, basic materials showed stronger antibacterial properties.

Prospective observation of a new bioactive luting cement: 2-year follow-up.

PURPOSE: A pilot study was conducted to determine the 2-year clinical performance of a new bioactive dental cement (Ceramir C&B, formerly XeraCem) for permanent cementation. MATERIALS AND METHODS: The cement used in this study is a new formulation class, a hybrid material comprising calcium aluminate and glass ionomer. Thirty-eight crowns and fixed partial denture (FPD) abutments were cemented in 17 patients. Thirty-one of the abutment teeth were vital, 7 nonvital. Six reconstructions were FPDs comprising 14 abutment teeth (12 vital/2 nonvital). A two-unit fixed splint was also included. Preparation parameters and cement characteristics (dispensing, working time, seating characteristics, ease of cement removal) were recorded. Baseline and postcementation data were recorded for marginal integrity, marginal discoloration, secondary caries, retention, and gingival inflammation. Tooth sensitivity was assessed at pre- and postcementation time points using categorical and visual analogue scale (VAS) assessment measures. RESULTS: Mixing of the cement was reported as "easy." Clinical working time for this cement was deemed acceptable. Assessment of seating characteristics indicated all restorations were seated completely after cementation. Cement removal was determined to be "easy." Fifteen of 17 subjects were available for 1-year recall examination; 13 patients were available for the 2-year recall examination. Restorations at 2-year recall examination included 17 single-unit, full-coverage crown restorations, four 3-unit FPDs comprising 8 abutments, and one 2-unit splint. No retentive failures or sensitivity were recorded at 2-year recall. Marginal integrities of all restorations/abutments at 2 years were rated in the "alpha" category. Average VAS score for tooth sensitivity decreased from 7.63 mm at baseline to 0.44 mm at 6-month recall, 0.20 mm at 1-year recall, and 0.00 mm at 2-year recall. The average gingival index score for gingival inflammation decreased from 0.56 at baseline to 0.11 at 6-month recall, then 0.16 at 1-year recall, and 0.21 at 2-year recall. CONCLUSIONS: Two-year recall data yielded no loss of retention, no secondary caries, no marginal discolorations, and no subjective sensitivity. All restorations rated "alpha" for marginal integrity at the 2-year recall. After periodic recalls up to 2 years, the new bioactive cement tested thus far has performed favorably as a luting agent for permanent cementation.

Clinical performance of a bioactive dental luting cement--a prospective clinical pilot study.

OBJECTIVE: To conduct a pilot study determining the clinical efficacy ofa new bioactive dental cement (Ceramir Crown & Bridge) for permanent cementation in fixed prosthodontics. The composition is a hybrid comprised of a calcium aluminate and a glass ionomer. METHODS: This study examined the performance of Ceramir Crown & Bridge after cementation of high-gold alloy and porcelain-fused-to-metal (PFM) single crowns and bridges. A total of 38 crowns and bridge abutments were cemented in 17 patients; 31 were on vital, seven on non-vital teeth. Six were bridges with 14 abutment teeth (12 vital/two non-vital). One fixed splint comprising two abutment teeth was also included in the study. Preparation parameters were recorded, as well as working time, setting time, seating characteristics, and ease of cement removal. Baseline data were collected on dispensing, mixing, and handling of the cement; gingival inflammation index (GI), and a visual analog scale (VAS) and categorical assessment measured pre-cementation sensitivity. Post-cementation parameters were post-cementation sensitivity, categorical and VAS, gingival tissue reaction, marginal integrity, and discoloration. A one-week post-op telephone call recorded subjectively the patients' comfort level. RESULTS: Working time (two minutes) and setting time (four minutes) were well within normal limits. Cement removal was determined to be very easy. Thirteen of 17 patients reported no post-cementation sensitivity after seven days; four reported a low-grade sensitivity. All 17 patients were seen for recall examinations at 30 days and six months. Of the four sensitivity cases, three were related to hyperocclusion, which disappeared spontaneously after adjustment. One case was due to post-cementation pressure from a three-unit bridge, which disappeared without intervention. After six months, no retentive failures were recorded, no sensitivity was subjectively reported, marginal integrity scored 38 alphas, one tooth had a 1 and two teeth a 0.5 GI score. Average VAS score for tooth sensitivity decreased from 7.63 mm at baseline to 0.44 mm at the six-month recall. Average GI score for gingival inflammation decreased from 0.56 at baseline to 0.11 at the six-month recall. CONCLUSION: After six months, Ceramir Crown & Bridge performed favorably as a luting agent for permanent cementation.

A comparative study of the bioactivity of three materials for dental applications.

OBJECTIVES: The aim of this work was to investigate the in vitro bioactivity of two different experimental dental luting cement formulations based on calcium aluminate (CA) in comparison with glass ionomer cement (GIC). One of the CA-based formulations was a hybrid between CA and GIC. METHODS: Samples were submerged in phosphate buffered saline and stored at 37 degrees C for four periods of time: 1 h, 1 day, 7 days and 4 weeks. After storage the samples were analyzed in order to investigate if a surface layer of hydroxyapatite had formed. The analysis techniques used included grazing incidence X-ray diffraction, scanning electron microscopy, energy dispersive spectroscopy and transmission electron microscopy. RESULTS: Both the CA-containing formulations were found to be bioactive. The highest degree of bioactivity was found on the sample with only CA as active substance. A relatively thick and totally covering layer was already formed after 24 h. On the hybrid material hydroxyapatite was found after 7 days. The GIC showed no bioactivity during the test period. SIGNIFICANCE: The utilization of a bioactive material for tooth restorations will give an opportunity for remineralization and a natural and durable seal of the tooth-material interface. Materials based on CA exhibit bioactivity.

Transmittance of a bioceramic dental restorative material based on calcium aluminate.

This article investigates the transmittance of a new ceramic filling material as a function of time, thickness, wavelength, and addition of pigments. In the hardened state the ceramic material is composed of hydrates, calcium aluminate, and glass fillers. The radiopacity of the investigated material is also measured. The results of the transmittance are compared to a commercial glass ionomer cement (Fuji II) and resin composite (Tetric Ceram). The transmittance increased with time from low values after 1 h to values close to the glass ionomer cements after 1 week. The resin composite had almost twice the transmittance as the calcium aluminate material and the glass ionomer cement. The amount of light passing through the material was dependent on both the sample thickness and the wavelength. Samples of 0.5-mm thickness transmitted almost twice as much as 1-mm-thick samples. Regarding the wavelength, blue light was scattered very effectively (low transmittance), whereas red light was not (high transmittance). Addition of pigments lowered the transmittance. The radiopacity was slightly higher than that of enamel.