Luting Cements Luting Cements And Delivering And Delivering the the final restorationfinal restoration

Luting Cements Luting Cements And Delivering And Delivering the the final restorationfinal restoration

Dr: Sharifa ALShehriDr: Sharifa ALShehriB.D.S,M.Sc.B.D.S,M.Sc.

431 SDS431 SDS

Reference: Rosenstiel. Land. Reference: Rosenstiel. Land. Fujimoto.4Fujimoto.4thth ed. pages: 909-927. ed. pages: 909-927.

Removing Provisional Removing Provisional RestorationRestoration

Bachhous forceps

Removing Provisional Removing Provisional RestorationRestoration

Richwill remover

Hayer bridge remover

Try-in Procedures for Cast Try-in Procedures for Cast Metal RestorationsMetal Restorations

Proximal contactProximal contact Marginal integrityMarginal integrity StabilityStability OcclusionOcclusion

Try-in of FPDTry-in of FPD

Try-in of Cast Post&CoreTry-in of Cast Post&Core

Checking for Proximal Checking for Proximal ContactsContacts

The most common problem seen in The most common problem seen in relation to a proximal contact is excessive relation to a proximal contact is excessive tightness.tightness.

Ideally the contacts should be stable and Ideally the contacts should be stable and easy to maintain.easy to maintain.

The proximal contact between the crown The proximal contact between the crown and a natural tooth should allow the and a natural tooth should allow the passage of flosspassage of floss

The operator should compare the contact The operator should compare the contact of other teeth in the dentition.of other teeth in the dentition.

Subjective symptoms (patients response) Subjective symptoms (patients response) are sufficient to confirm a tight contact.are sufficient to confirm a tight contact.

Proximal Contacts Proximal Contacts AdjustmentAdjustment

Checking for Proximal Contacts Checking for Proximal Contacts (Cont’d)(Cont’d)

Excessive tightness can be corrected Excessive tightness can be corrected by:by: Adjusting with a rubber wheel (all metal Adjusting with a rubber wheel (all metal

restoration)restoration) Adjusting with a cylindrical mounted stone Adjusting with a cylindrical mounted stone

(porcelain restoration)(porcelain restoration)

Deficient proximal contacts in a gold Deficient proximal contacts in a gold casting can be corrected by soldering .casting can be corrected by soldering .

Checking for Marginal Checking for Marginal Integrity Integrity

Margin adaptation with a gap around Margin adaptation with a gap around 3030m is clinically acceptable.m is clinically acceptable.

Marginal integrity can be assessed by Marginal integrity can be assessed by moving a sharp explorer from the moving a sharp explorer from the restoration to the tooth and from the restoration to the tooth and from the tooth to the restoration (open margin= tooth to the restoration (open margin= 50 µm the tip of sharp explorer can be 50 µm the tip of sharp explorer can be inserted between the restoration and inserted between the restoration and the tooth).the tooth).

What is the most common cause of What is the most common cause of poorly adapted margins?poorly adapted margins?

Checking for Marginal Checking for Marginal Integrity Integrity (Cont’d)(Cont’d)

Testing whether the casting binds to Testing whether the casting binds to the tooth surface, is helpful to the tooth surface, is helpful to determine the marginal integrity. This determine the marginal integrity. This can be done using the following can be done using the following materials:materials: Disclosing waxesDisclosing waxes Suspension of rouge in chloroform or ether Suspension of rouge in chloroform or ether

(Pressure indicating paste)(Pressure indicating paste) Air abrasion to form a matte finish Air abrasion to form a matte finish Powdered spraysPowdered sprays Water soluble marking agentsWater soluble marking agents Elastomeric detection paste (by far the most Elastomeric detection paste (by far the most

reliable-fit checker)reliable-fit checker)

Types Of Defective Types Of Defective MarginsMargins

Checking for StabilityChecking for Stability

The restoration should not rock or The restoration should not rock or rotate when a force is applied.rotate when a force is applied.

Instability produced by a small Instability produced by a small positive nodule on the fitting surface positive nodule on the fitting surface can be corrected by trimming.can be corrected by trimming.

If the instability is due to a distorted If the instability is due to a distorted wax pattern, the casting procedure wax pattern, the casting procedure should be repeated.should be repeated.

Checking for OcclusionChecking for Occlusion

Nonworking side interference

working side interferenceprotrusive interference

Checking for OcclusionChecking for Occlusion

Evaluation of Aesthetics Evaluation of Aesthetics in Ceramic Restorationsin Ceramic Restorations

Checking for the location of the Checking for the location of the incisal edgeincisal edge

Aesthetic Characterizations Aesthetic Characterizations Enamel cracksEnamel cracks Stained crack linesStained crack lines Exposed Occlusal dentinExposed Occlusal dentin Incisal halo.Incisal halo.

CEMENTATIONCEMENTATION

Cementation is Cementation is defined as, “The defined as, “The process of attaching process of attaching parts by means of a parts by means of a cement” –GPT.cement” –GPT.

Ideal Luting AgentIdeal Luting Agent Long working time.Long working time. Adhere well to both tooth structure and Adhere well to both tooth structure and

cast alloy.cast alloy. Provide a good seal.Provide a good seal. Non-irritating, non-toxic to both pulp and Non-irritating, non-toxic to both pulp and

surrounding supporting structure.surrounding supporting structure. Have adequate strength properties.Have adequate strength properties. Being compressible to thin layers i.e. have Being compressible to thin layers i.e. have

low viscosity; low solubility.low viscosity; low solubility. Exhibit good working and setting Exhibit good working and setting

characteristic.characteristic. Easily to be removed after setting.Easily to be removed after setting. Fluoride release.Fluoride release.

Types of luting agentTypes of luting agent

Zinc phosphateZinc phosphate Zinc silicophosphateZinc silicophosphate Zinc polycarboxylateZinc polycarboxylate Zinc oxide-eugenol with/without Zinc oxide-eugenol with/without

EBAEBA Glass ionomerGlass ionomer Adhesive resinsAdhesive resins Resin modified GIs Resin modified GIs

Cements bonding Cements bonding mechanismsmechanisms

Non-adhesive Non-adhesive mechanical mechanical lutingluting

Micro-Micro-mechanical mechanical bondingbonding

Molecular Molecular adhesiveadhesive

Zinc phosphate cementZinc phosphate cement

Zinc phosphate cement Zinc phosphate cement (1878(1878))

Composition:Composition: ZnO powder and phosphoric acidZnO powder and phosphoric acid

Advantages:Advantages: Long clinical track record (used Long clinical track record (used

clinically for over 50 years).clinically for over 50 years). Specimens of cement retrieved from Specimens of cement retrieved from

old castings (>40 yrs) show high old castings (>40 yrs) show high chemical stability .chemical stability .

Adequate strength (80-110 MPa c.s,5-7 Adequate strength (80-110 MPa c.s,5-7 MPa t.s).MPa t.s).

Reasonable working time (3-6min w.t, Reasonable working time (3-6min w.t, 5-14 s.t).5-14 s.t).

Excess material can be easily removed.Excess material can be easily removed.

Zinc phosphate cement Zinc phosphate cement (1878)(1878)

Disadvantages:Disadvantages: Water-sensitive during setting; Water-sensitive during setting;

microleakage; high solubility especially microleakage; high solubility especially in acid environment (0.05 to 3.3% in in acid environment (0.05 to 3.3% in d.w, 20 to 30 times higher in acids). d.w, 20 to 30 times higher in acids).

Pulp irritation Low initial pH (1-2 after Pulp irritation Low initial pH (1-2 after mixing, below 4 to 1 h,6-7 after 24 h); mixing, below 4 to 1 h,6-7 after 24 h); (use of varnishes?).(use of varnishes?).

Lack of antimicrobial actionLack of antimicrobial action Brittleness,Brittleness, lack of adhesion.lack of adhesion.

Zinc silicophosphate (1878)Zinc silicophosphate (1878)

High compressive strength High compressive strength (152 MPa) and a moderate (152 MPa) and a moderate tensile strength (9.3MPa) .tensile strength (9.3MPa) .

Excessive film thickness 88 Excessive film thickness 88 µm at the occlusal surface µm at the occlusal surface under an actual casting.under an actual casting.

An acidic pH that may be An acidic pH that may be harmful to the pulp.harmful to the pulp.

Zinc Polycarboxylate Zinc Polycarboxylate CementCement

Zinc Polycarboxylate Zinc Polycarboxylate Cement 1960sCement 1960s

Composition:Composition:

The powder is zinc oxide with 1% The powder is zinc oxide with 1% to 5% tin or magnesium oxide, to 5% tin or magnesium oxide, 10% to 40% aluminum oxide or 10% to 40% aluminum oxide or other reinforcing filler, the acid other reinforcing filler, the acid is 40% (high MW) polyacrylic is 40% (high MW) polyacrylic acid or acrylic acid coplymer acid or acrylic acid coplymer with other organic acids. with other organic acids.

Good for cementing crowns Good for cementing crowns and 3-unit bridges.and 3-unit bridges.

Zinc polycarboxylate cementZinc polycarboxylate cement ((Advantages)Advantages)

Exhibits specific (low) adhesion to tooth Exhibits specific (low) adhesion to tooth structure because it chelates with the structure because it chelates with the calcium. Adhesion to some alloys. calcium. Adhesion to some alloys.

Higher tensile strength (8-12 MPa) Higher tensile strength (8-12 MPa) compared to zinc phosphate cement, but compared to zinc phosphate cement, but significantly lower compressive strength significantly lower compressive strength (55-85 MPa).(55-85 MPa).

Anticariogenic in nature but this property is Anticariogenic in nature but this property is less than that of GIC.less than that of GIC.

Biocompatible to the pulp , rapid rise of the Biocompatible to the pulp , rapid rise of the cement PH toward neutrality.cement PH toward neutrality.

Lack of post operative sensitivity. (excellent Lack of post operative sensitivity. (excellent for sensitive teeth )for sensitive teeth )

Film thickness comparable to those of zinc Film thickness comparable to those of zinc phosphate cementsphosphate cements

Solubility in distilled water 0.1% to 0.6%.Solubility in distilled water 0.1% to 0.6%.

Zinc polycarboxylate Zinc polycarboxylate cementcement

DisadvantagesDisadvantages It is thixotropic in nature. Hence, it may It is thixotropic in nature. Hence, it may

be too thick and will not flow adequately.be too thick and will not flow adequately. Short (2.5min)working time as Short (2.5min)working time as

compared to that of Zn/Po cement(5min) compared to that of Zn/Po cement(5min) makes it difficult to lute long span makes it difficult to lute long span bridgesbridges

Residual cement is more difficult to Residual cement is more difficult to remove.remove.

Not as strong as Zn/Po.Not as strong as Zn/Po. Shows plastic deformation, so unsuited Shows plastic deformation, so unsuited

to high load areas to high load areas

Zinc polycarboxylate Zinc polycarboxylate Cement Cement

ManipulationManipulation The cement should be mixed on the surface The cement should be mixed on the surface

that does not absorb liquid; hence, a glass that does not absorb liquid; hence, a glass slab is preferred to treated paper pads.slab is preferred to treated paper pads.

The liquid should not be dispensed prior to The liquid should not be dispensed prior to mixing because it tends lose watermixing because it tends lose water

The powder is rapidly incorporated in bulk as The powder is rapidly incorporated in bulk as two increments into the liquid in large two increments into the liquid in large quantities within 30 seconds using a Glass quantities within 30 seconds using a Glass slab and stainless steel spatula.slab and stainless steel spatula.

Cooling the slab increases the setting time.Cooling the slab increases the setting time. Should not be disturbed in rubbery stage as Should not be disturbed in rubbery stage as

will pull from marginswill pull from margins

Glass ionomer cementGlass ionomer cement

Glass Ionomer Cements Glass Ionomer Cements 1970s1970s

Composition:Composition: alumino-fluorosilicate alumino-fluorosilicate glass and weak polyacrylic acidsglass and weak polyacrylic acids

Adhesive, and reports of reduced Adhesive, and reports of reduced microleakagemicroleakage

Early exposure to water significantly Early exposure to water significantly reduces ultimate strengthreduces ultimate strength

Low cement film thickness (25 to Low cement film thickness (25 to 35µm)35µm)

Does not appear to be more irritant Does not appear to be more irritant to pulp, as earlier reports suggestedto pulp, as earlier reports suggested

Glass Ionomer CementGlass Ionomer Cement AdvantagesAdvantages

Cement has adhesion to enamel and dentin Cement has adhesion to enamel and dentin (low bond strength to teeth).(low bond strength to teeth).

Exhibits good biocompatibility (no pulpal Exhibits good biocompatibility (no pulpal protection is required).protection is required).

It releases fluoride (anticariogenic effect).It releases fluoride (anticariogenic effect). Easy to mix , good resistance to acid Easy to mix , good resistance to acid

dissloution.dissloution. Set cement is translucent (advantage when Set cement is translucent (advantage when

used with porcelain labial margin).used with porcelain labial margin). Mechanical properties are comparable with Mechanical properties are comparable with

zinc phosphate cement (medium-high zinc phosphate cement (medium-high compressive strength 90 to 140 MPa, T.S 6 to compressive strength 90 to 140 MPa, T.S 6 to 8 MPa).8 MPa).

Glass Ionomer Cement Glass Ionomer Cement (Cont’d)(Cont’d)

DisadvantagesDisadvantages long term sensitivity can result if tooth is long term sensitivity can result if tooth is

over dried.over dried. High susceptibility to moisture High susceptibility to moisture

contamination. during setting, (more contamination. during setting, (more recent formulations may be less recent formulations may be less susceptible than the earlier products).susceptible than the earlier products).

Slow setting, possible pulp irritation.Slow setting, possible pulp irritation. variable adhesive characteristic. variable adhesive characteristic. Residual cement is more difficult to Residual cement is more difficult to

remove.remove.

Hybrid Ionomer CementsHybrid Ionomer Cements Resin modified polyalkenoate Resin modified polyalkenoate

cement (Mixture of resin and glass cement (Mixture of resin and glass ionomer powder)ionomer powder)

Combines the strength and Combines the strength and insolubility of resin with the fluoride insolubility of resin with the fluoride release of glass ionomer. release of glass ionomer.

Manufacturers recommend their use Manufacturers recommend their use for all-metal or ceramo-metal crowns for all-metal or ceramo-metal crowns and bridges, , but not for posts (risk and bridges, , but not for posts (risk of expansion induced root fracture)of expansion induced root fracture)

Not recommended for all-ceramic Not recommended for all-ceramic restorations, because delayed cement restorations, because delayed cement expansion can result in ceramic expansion can result in ceramic fracturefracture

Hybrid Ionomer Cementation Hybrid Ionomer Cementation (Cont.'s)(Cont.'s)

Working time can be lengthened by Working time can be lengthened by using refrigerated liquid, mixing on using refrigerated liquid, mixing on cold slab or decreasing powder-liquid cold slab or decreasing powder-liquid ratio. Higher temperature shorten ratio. Higher temperature shorten working time.working time.

Use microetching to prepare internal Use microetching to prepare internal metal surfaces for increased bonding.metal surfaces for increased bonding.

Remove excess cement before final Remove excess cement before final set.set.

Use desensitizing liquid to reduce Use desensitizing liquid to reduce possible sensitivity without possible sensitivity without dramatically affecting bond to tooth.dramatically affecting bond to tooth.

Adhesive resin agentsAdhesive resin agents

Adhesive resin agentsAdhesive resin agents Composition: Bis-GMA resins and other Composition: Bis-GMA resins and other

methacrylates . methacrylates . Available in a wide range for Available in a wide range for

formulation. These can be categorized formulation. These can be categorized on the basis of polymerization intoon the basis of polymerization into::(Chemical-, photo- and dual-cure)(Chemical-, photo- and dual-cure)

Adhesion to enamel by Adhesion to enamel by micromechanical retention to dentine micromechanical retention to dentine by more complex penetration of by more complex penetration of hydrophilic monomers through hydrophilic monomers through collagen layer overlying partially collagen layer overlying partially demineralized apatite of etched dentinedemineralized apatite of etched dentine

Adhesive resin agentsAdhesive resin agents

Adhesive resin agents Adhesive resin agents (cont.)(cont.)

Conditioning: removal of smear layer, Conditioning: removal of smear layer, and demineralize top 2-5 micronsand demineralize top 2-5 microns

Primer: wetting agent such as HEMA Primer: wetting agent such as HEMA (Hydroxy Ethyl Metacrylate ) applied; (Hydroxy Ethyl Metacrylate ) applied; bifunctionality enables hydrophilic bifunctionality enables hydrophilic bond to dentine and hydrophobic bond to dentine and hydrophobic bond to adhesivebond to adhesive

Adhesive cement: e.g. 4-Adhesive cement: e.g. 4-META(Methacryloxy Ethyl Ttimillitic META(Methacryloxy Ethyl Ttimillitic Anhydride) penetrates into tubulesAnhydride) penetrates into tubules

Polymerization shrinkage remains a Polymerization shrinkage remains a problemproblem

Adhesive ResinsAdhesive Resins

The manipulative techniques may The manipulative techniques may be very different with different be very different with different brands of resin cements.brands of resin cements.

Shade of veneers can be modified Shade of veneers can be modified by the shade of the luting agent by the shade of the luting agent

Colour-match try-in pastes are Colour-match try-in pastes are available to facilitate selecting available to facilitate selecting the best cement shade.the best cement shade.

Adhesive ResinsAdhesive Resins

Advantages:Advantages: high strength, high strength, low oral solubility.low oral solubility. high micromechanical high micromechanical bonding to prepared bonding to prepared enamel, dentin, alloys and enamel, dentin, alloys and ceramic surfaces.ceramic surfaces.

Adhesive ResinsAdhesive Resins Disadvantages: Disadvantages:

The need for meticulous and The need for meticulous and critical technique,critical technique,

More difficult sealing and higher More difficult sealing and higher film thickness than traditional film thickness than traditional cements, cements,

Possible leakage and pulp Possible leakage and pulp sensitivity, sensitivity,

Difficulty in removal excess cementDifficulty in removal excess cement

Provisional Provisional cementationcementation

Zinc oxide –eugenol: powder zinc oxide, Zinc oxide –eugenol: powder zinc oxide, the liquid is purified eugenol.the liquid is purified eugenol.

Low compressive and tensile strength(7-Low compressive and tensile strength(7-40 MPa, 1000-6000P psi).40 MPa, 1000-6000P psi).

Film thickness of 40 µmFilm thickness of 40 µm High solubility about 1.5%, little High solubility about 1.5%, little

anticariogenic actionanticariogenic action Abtudent effect on the pulp, good sealing Abtudent effect on the pulp, good sealing

ability and resistance to marginal ability and resistance to marginal penetration.penetration.

Reinforced zinc oxide-eugenol cements: Reinforced zinc oxide-eugenol cements: by adding EBA, alumium oxide and PMM. by adding EBA, alumium oxide and PMM.

Provisional CementsProvisional Cements

Definitive cementationDefinitive cementation Primary purpose of luting Primary purpose of luting

cement: to seal tooth-restoration cement: to seal tooth-restoration interfacial spaceinterfacial space

Choice of luting agentChoice of luting agent Type of restoration: conventional Type of restoration: conventional

casting or adhesive restorationcasting or adhesive restoration

Clinical decision making for Clinical decision making for dental cementsdental cements

Clinical decision making for Clinical decision making for dental cementsdental cements

Preparation of Tooth Preparation of Tooth SurfaceSurface

After cleaning the preparation, After cleaning the preparation, cavity varnish should be cavity varnish should be applied if a non-adhesive applied if a non-adhesive cement like zinc phosphate is cement like zinc phosphate is to be used.to be used.

Oxalate treatment of the tooth Oxalate treatment of the tooth surface can be done to reduce surface can be done to reduce dentin sensitivity.dentin sensitivity.

Preparing the casting:Preparing the casting: The casting should be cleaned by sandblasting with 50 The casting should be cleaned by sandblasting with 50 m m

alumina or by steam, followed by ultrasonic or organic alumina or by steam, followed by ultrasonic or organic cleaning.cleaning.

Next the operatory site is isolated with cotton rolls.Next the operatory site is isolated with cotton rolls. The cement should be mixed to a luting consistency.The cement should be mixed to a luting consistency. A thin coat of cement should be applied on the internal A thin coat of cement should be applied on the internal

surface of the casting.surface of the casting. The tooth surface is dried and the prosthesis is inserted The tooth surface is dried and the prosthesis is inserted

with a firm, rocking dynamic seating force. A static load with a firm, rocking dynamic seating force. A static load will lead to incomplete seating. Excessive force may lead to will lead to incomplete seating. Excessive force may lead to fracture.fracture.

Next the margins of the retainers are examined to verify the Next the margins of the retainers are examined to verify the fit of the prosthesis.fit of the prosthesis.

Excess cement should be removed with an explorer. Floss Excess cement should be removed with an explorer. Floss can be used to remove the excess cement in the inter-can be used to remove the excess cement in the inter-proximal surface.proximal surface.

Occlusion should be checked with Mylar shim stock or Occlusion should be checked with Mylar shim stock or articulating paper.articulating paper.

The patient should be advised to avoid loading for the first The patient should be advised to avoid loading for the first 24 hours.24 hours.

Preparation of the Restoration Preparation of the Restoration and Tooth Surface for Final and Tooth Surface for Final

CementationCementation

Cementation with Zinc Phosphate Cementation with Zinc Phosphate cementcement

Pdr1.2mg+Lq0.6ml

Cementation with Zinc Cementation with Zinc Phosphate cementPhosphate cement

Cementation with Zinc Cementation with Zinc Phosphate cementPhosphate cement

Cementation with Zinc Phosphate Cementation with Zinc Phosphate cementcement

Cementation with Zinc Cementation with Zinc Phosphate cementPhosphate cement

Factors that influence the Factors that influence the completeness of seating after completeness of seating after

cementationcementation

Viscosity of the cement.Viscosity of the cement. Morphology of the Morphology of the

restoration.restoration. Vibration.Vibration. Seating force.Seating force. Venting.Venting.

Venting.Venting.

Cementation with Glass Cementation with Glass IonomerIonomer

Clean tooth and isolate. Do not use Clean tooth and isolate. Do not use compressed air. If tooth is dry, compressed air. If tooth is dry, moisten with a wet cotton roll.moisten with a wet cotton roll.

Excessive air drying of the Excessive air drying of the preparation may cause post-preparation may cause post-cementation sensitivity.cementation sensitivity.

Seat casting, then clean up excess Seat casting, then clean up excess cement after it hardens.cement after it hardens.

If patient has sensitivity, delay final If patient has sensitivity, delay final cementation for 2-3 weeks.cementation for 2-3 weeks.

Technique TipsTechnique Tips Fluff powder before dispensing. Hold liquid Fluff powder before dispensing. Hold liquid

bottle vertically, and release each drop slowly to bottle vertically, and release each drop slowly to ensure equal size drops.ensure equal size drops.

For any powder/liquid cement, incorporate the For any powder/liquid cement, incorporate the powder thoroughly. Insure mix is homogeneous.powder thoroughly. Insure mix is homogeneous.

Load the crown evenly with cement.Load the crown evenly with cement. Place crown cement-side done on your palm for Place crown cement-side done on your palm for

the dentist to pick up and seat on the tooth.the dentist to pick up and seat on the tooth. As the cement loses its gloss and start to set, it As the cement loses its gloss and start to set, it

will have a stringy, non-sticky consistency. Start will have a stringy, non-sticky consistency. Start removing excess cement before it hardens.removing excess cement before it hardens.

After removal of excess, use a piece of knotted After removal of excess, use a piece of knotted floss and run it through the interproximal areas floss and run it through the interproximal areas to remove remnant cement.to remove remnant cement.

Instruct patients to wait 1 hour after Instruct patients to wait 1 hour after cementation.cementation.

Hybrid Ionomer Hybrid Ionomer CementationCementation

Clean tooth.Clean tooth. Rinse and dry – do not desiccate the Rinse and dry – do not desiccate the

tooth.tooth. Powder is sensitive to moisture – keep Powder is sensitive to moisture – keep

container tightly sealed.container tightly sealed. Fluff powder before dispensing.Fluff powder before dispensing. Make sure tip of liquid vial is clean Make sure tip of liquid vial is clean

before dispensing.before dispensing. Dispense liquid form vial held Dispense liquid form vial held

vertically to ensure uniform drops.vertically to ensure uniform drops. Mix all powder into liquid for 20-30 Mix all powder into liquid for 20-30

seconds on a small area of mixing pad.seconds on a small area of mixing pad.

Post-Cementation Post-Cementation InstructionsInstructions

The patient is asked to exercise all oral functions The patient is asked to exercise all oral functions and awareness should be created regarding the and awareness should be created regarding the initial discomfort.initial discomfort.

Sudden impact forces should be avoided in the Sudden impact forces should be avoided in the restored area, e.g. biting on a nut or metallic restored area, e.g. biting on a nut or metallic object.object.

Maintenance:Maintenance: Oral hygiene procedures with special attention to use Oral hygiene procedures with special attention to use

of floss, inter-dental brushes in the concerned area.of floss, inter-dental brushes in the concerned area. De-sensitizing tooth paste or mouth wash can be used De-sensitizing tooth paste or mouth wash can be used

if there is sensitivity.if there is sensitivity. The patient is advised to report immediately if The patient is advised to report immediately if

there is pain.there is pain. Regular recall visits for review.Regular recall visits for review.

Follow-up CareFollow-up Care

Post-cementation appointment (within Post-cementation appointment (within a week to 10 days)a week to 10 days)

Periodic recall – patients with cast Periodic recall – patients with cast restoration are recalled at least every restoration are recalled at least every six monthssix months

Patients with extensive fixed prosthesis Patients with extensive fixed prosthesis combined with advanced periodontal combined with advanced periodontal disease needs more frequent recall disease needs more frequent recall appointments.appointments.