When practitioners look across the dental industry for new materials, and specifically dental cements, there are a myriad of options that we can choose from. There are some cements that do specific things very well but are not as strong in other aspects, whereas other cements claim to do everything we would need in our practices.
When determining which cement to use or which is ideal, the answer can become very complex. Even dentists or specialists who normally aren’t preparing, temporizing, or fabricating crowns will occasionally have to deal with a patient’s crown coming off. The scale and diversity of these cement offerings is incredibly complex, and as such, many materials and clinical circumstances must be considered for an ideal cement.
The usual questions that dentists likely will ask about cements are also fairly wide ranging. Although these are not representative of all the questions one might ask, they may include the following:
- Which substrates will these cements adhere to?
- Will it bond to dentin and enamel?
- Which types of crowns can be used with this cement?
- How will I know that it will achieve a completely uniform distribution of a 103.5-µm cement thickness layer across the entire intaglio surface of our restorations?
To further complicate the selection of an ideal cement, practitioners must consider several more factors, including but not limited to:
- Ease of use
- Bioactivity and pulpal regeneration
- Flexibility in the presence of blood or other contaminants
- Bisphenol A–free biomaterials in the cement itself
- Long-term flexural similarity with natural tooth structure
SDI, an international leader in introducing innovative and highly practical products to the clinical dental armamentarium, has recently introduced a unique and effective cement product called Riva Cem Automix. This is a resin-modified glass ionomer (GI) luting cement that comes from a single syringe and is
dispensed through a mixing tip. What makes this cement product different from the host of resin-modified GI luting cements that currently exist in the marketplace is the use of a proprietary technology called ionglass. Within the cement is a blend of different sized glass-reactive particles that release both fluoride ions and cross-link polycarboxylic chains, resulting in a better bond strength and more stable esthetic properties.
In addition to the improvement in strength and esthetics, it is delivered through a unique smaller-sized mixing tip, allowing for less waste and greater economy. Along with that, in contrast to several other cement options, this cement boasts an easier and more efficient cleanup after the 5-second tack cure. It doesn’t require primers on either the restoration or the tooth, which greatly increases clinical efficiency.
Catapult Evaluation
Riva Cem Automix was given to 14 members of the Catapult Education product evaluation group, which consisted of mostly general dentists coming from a variety of clinical environments and patient demographics. During the evaluation phase, the participating dentists used the product for crowns, bridges, inlays, onlays, implant crowns, and veneers. All the participants found the tip to fit securely, with an acceptable length and minimal waste vs other systems in the market, and reported it as perfectly sufficient for clinical needs. Only 1 of us found the 5-second setting time unacceptable. From a practical perspective, I would agree that having a 2- to 3-second tack cure would save me a lot of time during the day to do other, more productive things—like drink more coffee or ponder the origins of our great profession.
When evaluating the tack cure feature, all but 1 of us found the cement cleanup to be easier or the same as our current product of choice. More than 57% of evaluators were strongly impressed with the cleanup. In terms of shade, 93% of evaluators found the product shade to be acceptable for GI cementation, 100% found the product to be homogeneous in its consistency, and 100% found the product to be suitable for the purpose of successful and efficient cementation. All either agreed or strongly agreed with the statement, “Overall, I can use this material as intended for my dentistry needs.” Only 1 person marked neutral, and no evaluators marked either disagree or strongly disagree. All evaluators agreed that Riva Cem Automix is a suitable product in a dental setting, and 93% of the respondents said they would recommend it to a colleague.
Clinical Example
The following patient presented for crown fabrication due to recurrent decay under an existing defective restoration with fractures through the mesial and distal marginal ridges on #5. Clinically, the tooth was reconfirmed for the diagnosis of cracked tooth syndrome.
Cold testing was performed to determine pulp vitality. The pain and thermal sensitivity did not linger with testing that day, and the pain was only on release of the bite stick. Prior to the delivery of anesthesia, a preprocedural rinse with StellaLife was used, and intraoral scans using CEREC Primescan (Dentsply Sirona) were taken to use for fabrication. Along with the usual opposing scan and bite scan, a Biocopy scan was also taken of the tooth to be used in the fabrication process as needed.
After the patient achieved profound anesthesia with 4% Septocaine with 1:100,000 epinephrine (Septodont), the tooth was prepared in a normal manner to remove prior restorative material and the recurrent decay. After removing the decay, Sable Seek (Ultradent) was placed on the prep to confirm whether any remaining decay was present. Next, a core buildup was placed using RE-GEN Flowable (Vista Apex) after my standard bonding protocol, and the prep was finalized (Figure 1).
Prep scan was then taken and used to fabricate the restoration in office. The crown was tried on, verifying the margins were closed, and a precementation radiograph was taken. The zirconia crown was then microetched using 50-µm aluminum oxide to remove any remaining organic phosphates, smear layer, and tissue debris on the intaglio surface. In my clinical theater, the preparation still needs to be treated prior to cementation. SDI recommends using their Riva Conditioner to help with optimum adhesion and if clinically close to the pulp, where you need protection to use a liner/base of choice.
Figure 1. A core buildup was placed using RE-GEN Flowable from Vista Apex after standard bonding protocol and the prep was finalized. | Image Credit: © Clinical images courtesy of Ben Alvarez, DDS
Figures 2 and 3. The crown was filled with Riva Cem Automix , placed onto the prep, and light cured in place.
Figures 2 and 3. The crown was filled with Riva Cem Automix , placed onto the prep, and light cured in place.
Figure 4. Excess cement was removed from all surfaces and allowed to sit.
Figure 5. A postop cementation radiograph.
I use Clean & Boost (Vista Apex) to clean the prep after it has been scrubbed for 20 seconds. This removes smear layer and debris, etches the enamel, and can help with minor bleeding to help get an ideal surface to cement or bond to. I also scrub the preparation for 5 to 10 seconds with BondSaver (Vista Apex) and remove any excess with a dry microbrush, leaving the surface wet but not pooled. Doing this will help create a better surface for the resin in Riva Cem Automix to bond to and minimize postoperative sensitivity.
The crown was filled with Riva Cem Automix, placed onto the prep, and light cured in place for 5 seconds on each side of the tooth (Figures 2 and 3). Excess cement was removed from all surfaces with an explorer and allowed to sit for an additional 5 minutes with firm-even pressure with a highly complex absorbing medium, typically a cotton roll (Figure 4). Afterward, the occlusion was checked (adjusted if needed), the contacts were checked, and a postoperative cementation radiograph was taken to confirm that cement removal was successful (Figure 5).
Conclusion
As dentists, we always seek ways to be more cost-efficient in our techniques and with products that will ultimately create an equal to or more superior outcome. Catapult Education has stringent criteria that must be met to attain the Catapult Vote of Confidence, requiring that a certain percentage of evaluating clinicians must rate a product as either very good or excellent, must intend to recommend the product to colleagues, and must intend to continue using the product. For this reason, it is without hesitation that we would like to bestow the Catapult Vote of Confidence upon SDI for Riva Cem Automix.
