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| IMC Wiki | Cement types for base fillings (3) - Zinc oxide eugenol cements, carboxylate cements, and cements containing calcium hydroxide

Cement types for base fillings (3) - Zinc oxide eugenol cements, carboxylate cements, and cements containing calcium hydroxide

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Zinc oxide eugenol cements (ZOE cements)

ZOE cements consist of zinc oxide and clove oil (oil made from the bud and leaves of the clove spice plant).
Product examples: zinc oxide eugenol special paste, Cavitec, Pulpal
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Working with ZOE cements

Special tips with regard to working with ZOE cements:

The curing process of ZnO eugenol compounds is accelerated by humidity (saliva, breath). Powder and liquid should, therefore, not be exposed to air and the bottles resealed again immediately.

As pure clove oil, or eugenol, can have a toxic effect on the dental pulp via the dentinal tubules, the firmest possible, ie powder-rich, mixture should be made. It is important in so doing that the mixture is beaten together vigorously over a long period of time. A large amount of powder can be beaten into the liquid. The consistency is right when the paste is so stiff that it can only just be worked. Mixing the paste ineffectually and for too short a period of time would be a mistake as the paste would cure too quickly.

Reinforced ZOE cements
Plastic additives (polymethyl methacrylate polymers, polystyrene, polycarbonate) have been used in an attempt to improve the strength of ZOE cements.
Product example: IRM

Ethoxy benzoic acid ZOE cements (EBA cements)
The term EBA cement originated in English and stands for ethoxy benzoic acid.
By replacing a part of the eugenol with 2 ethoxy benzoic acid and by replacing a part of the zinc oxide with inorganic filler (above all Al2O3), attempts have been made to improve the classic ZOE cements.
Product example: Harvard Eugenat Cement

Carboxylate cements

Carboxylate cements were developed in the 1960s especially as adhesive cements. The big disadvantage of these cements is their relatively high propensity to dissolve in saliva, shown by the comparatively high proportion of lost restorations. The composition of the powder is comparable to that of PHC though as a liquid, polyacrylic acid replaces phosphoric acid.
Product example: carboxylate cement, Harvard CC carboxylate cement, Durelon

Calcium hydroxide (Ca(OH)2)

Ca(OH)2 in itself is not a cement but is frequently added to cements or used underneath cements to protect the dental pulp.

The most important effect of Ca(OH)2 lies in its pH value which lies in the alkaline range of 12 to 13. This pH value allows the release of hydroxyl ions (OH)-) in water.
Because of this property, Ca(OH)2 when used in the damaged dentine of deep cavities, is purported to have the following effects:
  • Neutralisation of the acidic pH value released from infective dentine and in the dentine pulp, altered as a result of inflammation, by caries.
  • Disinfection as a result of the bactericidal effect of the pH value.
  • Desensitisation of the dentine by reducing its permeability.
  • Encouraging the formation of new hard tissue (tertiary dentine).

Non-curing (Ca(OH)2 compounds (aqueous solutions and pastes)

A solution of Ca(OH)2 powder and water, always made up freshly, is the most effective, simplest and least expensive compound. (Ca(OH)2 powder from the pharmacist as proscribed in the formulary; Merck, Darmstadt, Germany).
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The powder is mixed with water (because of the bactericidal effect of Ca(OH)2 tap water is sufficient) until a curd-like consistency is attained which can then be introduced into the cavity. The surplus of water needs to be dabbed away using cotton wool pellets. These Ca(OH)2 solutions are also introduced into the root canal as a medicinal filler in endodontics.

Well known ready-made products are Calxyl® red for direct pulp capping and Calxyl® blue and Hypocal® for indirect pulp capping or the treatment of deep caries. Calxyl® blue and Hypocal® have had barium sulphate (BaSO4), an x-ray contrast material, added. As contrast materials can penetrate the vital tissue if they come into contact with the dental pulp and have a negative influence on the healing process, calcium hydroxide products which contain barium sulphate should not be used for direct pulp capping.

Curing Ca(OH)2 compounds

Ca(OH)2 cements on the basis of salicylate
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In general, these cements consist of a basic paste and a catalytic paste (plasticizer). By mixing the two, the cement cures. Product example: Dycal®, Life® (Kerr) and Reokap® (Vivadent).

Ca(OH)2 zinc oxide eugenol cements
Indication and application are the same as for ZOE cements.
Product example: Cp-Cap

Ca(OH)2 zinc oxide phosphate cements
Indication and application are comparable with those of PHC cements. Product example: Dropsin®. However, this type of cement does have one disadvantage: the Ca2 effect is neutralised by the phosphoric acid which has been added, and at the same time the stability is markedly inferior to that of PHC.