All Posts

Expect More From Your Cement


     It would appear that Tokuyama Dental has again come up with another material that combines multiple steps into one single step. EsteCem II is a dual cure resin cement with some interesting properties, simplifying the cementation of all types of restorative materials. Included with the kit is Tokuyama Universal Bond, which is used as a pretreatment to enhance the bonding to tooth structure and substrate material. In terms of its chemistry, Tokuyama Universal Bond wears many hats, and has the ability to bond to all materials. As an example, it will etch, prime and bond to tooth structure in one step and will also act as a silane for glass materials such as ceramics and porcelain.   

     After using it for nearly a year, what stood out to me clinically was the ability of EsteCem II to adhere to all substrates. That includes zirconia, all types of precious, semi, and non-precious metals, ceramics, and resin-based materials, among others. How it does make life easier when it comes to cementation of indirect restorations can be demonstrated with the following cases, each requiring its own preparation style and unique material.



     Once the tooth was anesthetized, the provisional crown was removed, the prep cleaned and Tokuyama Universal Bond applied to the damp dentin and the intaglio surface of the zirconia crown. After drying, EsteCem II resin cement was injected into the crown and the fixed restorative seated on the prep. After light curing for three seconds, excess cement was removed easily from around the margins and interproximal areas. The crown was then reevaluated for any occlusal discrepancies, and polished using Jazz polishers (SS White).

              Fig.1                                                Fig.2
fig. 1

              Fig.3                                                 Fig.4 



                                                      CASE #2

     I selected the second case to show the cementation of a high particle filled resin onlay. Following local anesthesia, the provisional was removed and the prep cleaned. The site was prepared for cementation using a Reel Matrix (Garrison) to  provide excellent isolation, and preventing the cement from leaking outside the preparation into the interproximal areas. Tokuyama Universal Bond was then applied to enamel and damp dentin, as well as the intaglio surface of the onlay. After drying both the prep and onlay, EsteCem II (Brown Shade) was injected directly into the cavity preparation and the onlay seated to place.  

                    Fig.1                                            Fig.2

                         Fig. 3                                             Fig. 4

     EsteCem II excess was removed after an initial 3 second tack cure. The beauty of using a matrix is that allows the cement to be set for several minutes, providing a firm set in the proximal sites.

      After matrix removal, the occlusion was adjusted and the restoration polished. Notice that selection of the brown EsteCem II shade allowed for perfect blending of the onlay, especially at the margins.



EsteCem II (Tokuyama Dental):

     This case required an increase in incisal height of both lower cuspids in order to regain canine protected occlusion. Following local anesthesia, the provisional veneers were removed, the prep cleaned, and Tokuyama Universal Bond applied to both the veneer and the tooth surface. Because veneers are often made to fit an already existing area of contact, shims, strips and other blockout interproximal strips should not be used. They often occupy the space needed for cement to properly seal the margins.

     EsteCem II Universal shade was selected and injected into the veneer.  It is critical that an adequate amount of cement is dispensed into the intaglio of the veneer, making sure to fill the veneer with enough resin cement thus avoiding air pockets, compromised esthetics and potential fracturing. The restoration was seated in the place and the cement cured, the completed veneer immediately following cementation, adjustment and polishing.

               Fig.1                                                       Fig.2





              Fig.3                                                        Fig.4


Dr. Ian Shuman, DDS, MAGD, AFAAID
Dr. Ian Shuman, DDS, MAGD, AFAAID
Dr. Ian Shuman maintains a full time general, reconstructive and aesthetic dental practice in Pasadena, Maryland. Dr. Shuman is the Editorial Director of Continuing Education for PennWell Publishing. He is a Master in the Academy of General Dentistry, an Associate Fellow of the American Academy of Implant Dentistry, and a Fellow of the Pierre Fauchard Academy. Dr. Shuman was named one of the Top Clinicians in Continuing Education since 2005 by Dentistry Today. An educator and author, Dr. Shuman is a pioneer in developing advanced, minimally invasive techniques.

Related Posts

12 Minutes to Pain Relief and Cosmetic Nirvana

Dr. Brian Gray – Washington, DC

Composite Applications for Our Pediatric Patients

By Carla Cohn DMD There are so many excellent composite resin materials to choose from in the dental market today that it can be overwhelming to know which to use, and when. Many of the composite resin materials come with features that are compelling. Bioactivity, bulk fill, sonic fills, ultra-polishable, low shrinkage, self leveling, nano hybrid, specialized aesthetic shading systems, universal use, the list of attributes available goes on and on. Ultimately, we want the very best for our patients and their restorations. At the same time, it is inconceivable that we carry the inventory in our practice of each material that has a distinct attribute. A simple and unique solution is OMNICHROMA, a resin restorative material manufactured by Tokuyama Dental America. OMNICHROMA combines a number of excellent properties such as excellent esthetic properties due to uniform sized 260 nm supra-nano spherical SiO2-ZrO2 filler particles. These fillers result in unprecedented color matching, extremely high polishability, and color stability. Physical-mechanical properties due to the types of fillers and high fill content of 79% weight/68% volume give the material high wear resistance, high compressive strength, and exceptional handling. As the name implies OMNI = all, or universally + CHROMA = a quality of color combining hue and saturation (Merriam Webster Dictionary). OMNICHROMA is a universal shade that blends and reflects allowing us to be able to use this one OMNICHROMA composite shade for a multitude of different tooth shades. Little patients have little patience. When treating children, simplicity and durability of materials is key to successful restorations. The less time spent in a child’s mouth, the better. Although primary dentition is transitional, the occlusal forces, bruxing, and wear and tear are substantial in a short period of time. Intracoronal restorative materials for primary teeth must deliver reliable physical and mechanical properties in order to have successful long-lasting restorations. In my experience, highly filled composite resin combined with excellent isolation and technique yield reliable restorations. Case study #1  4-year-old boy presented with early childhood caries. I completed full mouth rehabilitation under general anesthetic consisting of full coverage crowns, intra-coronal composite restorations, and extractions. The focus and feature in this case study is a simple intra-coronal restoration on primary tooth H / 63. Pre-operative photos showing caries and a shade guide for reference. Teeth were prepared using a high-speed Pana-Max (NSK) with a #556 carbide bur ensuring an adequate undercut in preparation to incorporate some mechanical retention. Figures 1 - 2. Enamel was etched using phosphoric acid etch and Bond Force (Tokuyama Dental America) as adhesive in a selective etch technique and light cured. In this case, due to some remaining dark dentin, OMNICHROMA BLOCKER (Tokuyama Dental America) was used and light cured. Figure 3. OMNICHROMA (Tokuyama Dental America) was placed in bulk (2mm), as the lesion was minimal in depth and light cured. Figures 4 - 5. Resulting restoration shade blended beautifully providing a functional and aesthetic result. Figure 6.

Providing Free Dental Care in Mexico to the Uninsured

By: Rutu Shah