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Cementation Using Rubber Dam Isolation

 Bisco All-Bond Universal black bottle no cap

When it comes to all dental procedures, reliability and efficiency are key. Reliability comes with establishing protocols based on research and science. Efficiency comes with developing those protocols with your team. This is especially true when bonding ceramic restorations, specifically lithium disilicate, feldspathic and leucite reinforced restorations.

Ensuring optimal bond with cementation of porcelain restorations can be both reliable and efficient. The key ingredient centers around teamwork.

The assistant’s roll is critical in achieving success. Included below is a guideline to optimize the in-operatory efficiency specifically for lithium disilicate, feldspathic and leucite reinforced restorations. Protocols for cementation of other restorations such as zirconia, PFZ, and metal ceramic, while similar, require different steps unique to the material being cemented.

Step 1
Remove the provisional restoration and ensure the fit of the final restoration. Make any adjustments to the restoration as needed.

Step 2
Once the fit is confirmed, it’s time to start the cementation protocol.

Step 3
Apply porcelain etch (9.5% Hydrofluoric Acid) to the intagliomsurface of the crown (Figure 1). While you’re applying the etch, the assistant is preparing the silane (Figure 2). After 20 seconds (lithium disilicate) or 90 seconds (feldspathic, leucite reinforced) rinse out the etch with copious water and air dry. Surface should appear matte (Figure 3).

Step 4
Apply a thin layer of silane to the intaglio surface of the crown. Then place the crown under a piece of gauze or in a dark box to keep it out of the light.

Step 5
Prepare the tooth for cementation under rubber dam isolation.

Step 6
Clean surface with microabrasion (Figure 4). Etch the tooth for 15 seconds (35% Phosphoric Acid with BAC) (Figure 5). While etching the tooth, the assistant dispenses All-Bond Universal in the dish and covers (Figure 6). Rinse with copious water for 5 seconds and blot dry with cotton (Figure 7). Be careful not to over dry the tooth.

Step 7
Scrub All-Bond Universal onto the prepped tooth in 2 20-second intervals (Figure 8). The assistant holds out extra bond near the site for easy reapplication. Air thin only after second coat for 10 seconds (Figure 9). Light cure for another 10 seconds (Figure 10).

Step 8
As you are curing the bond, the assistant loads the crown with the Duo-Link Cement and holds out the crown ready for placement as soon as the light shuts off.

Step 9
Place the crown (Figure 11) and tack-cure the cement for 5 seconds on facial and lingual (Figures 12,13). Remove cement with an explorer and floss through both contacts (Figure 14).

Step 10
Set a timer for 5 minutes and allow cement to fully polymerize. Take off the rubber dam, and finalize the occlusion and polish (Figure 15).

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Figure 1

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Figure 2

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Figure 3

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Figure 4

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Figure 5

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Figure 6

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Figure 7

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Figure 8

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Figure 9

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Figure 10

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Figure 11

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Figure 12

Courtesy of Dr Devin McClintock

 

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