- Email: [email protected]
Permanency of EBA cement
t ie n t s h a v e n o t s e e n a d e n t i s t in t e n
choose
y e a rs .
d e n tu ris t
to
m ake
th e ir
d e n tu re ,
th e
w e ll as h ig h ly re s is ta n t to a b ra s io n .
tw o
I f s c r a t c h e d o r p o lis h e d o f f , i t im m e d
s t a t e t h e p a t ie n t s h a v e n o t s e e n a d e n
y e a r s ’ e x p e r i e n c e , w e a lr e a d y k n o w
ia t e ly fo rm s a n e w a n d id e n tic a l c o a t
t i s t i n 15 t o 2 0 y e a r s . T h i s h o ld s t r u e
th e a n s w e r.
in g u n d e r m o s t c o n d it io n s .
W ith
50%
a c c u ra c y ,
we
can
r e g a r d le s s o f w h e t h e r t h e y a r e e d e n t u lo u s o r n o t .
or
th e
d e n tis t?
W ith
T h e o n l y p r o b l e m is i n f o r m i n g t h e
O LIN E . FREEDM AN
p u b l i c , l e t t i n g t h e m k n o w a n a lt e r n a
CON SU LTANT TO M A NAGEM EN T IN
s u p p o rt
GRAPHICS COM M UNICATIONS
h a v e n o t a c c e p te d th e r h e to r ic o f th e
a n d e n d o rs e th e c o n c e p t o f a c e n tra l
IN D U STR IE S, CHICAGO
d e n ta l
lis t in g w i t h a t o l l - f r e e c o n s u m e r i n f o r
F o r w h a t e v e r r e a s o n , t h e s e p e o p le
p ro fe s s io n .
They
have
not
tiv e
e x is t s .
T h e re fo re ,
we
b ru s h e d a f t e r e v e r y m e a l, th e y h a v e
m a tio n
n o t u s e d d e n t a l f lo s s , a n d t h e y h a v e
p h o n e n u m b e r a p e rs o n c a n c a ll t o f in d
n o t s e e n t h e ir d e n tis t t w ic e
a y e a r.
o u t t h e i n d iv id u a ls o r c lin ic s n e a r h i m
t e l l t h i s s a m e g r o u p o f p e o p le
th a t p r o d u c e q u a lity d e n tu re s a t e c o n
■ I a m h a v in g a p r o b le m in m y p r a c
s h o u ld
o m ic a l p r ic e s .
t ic e a n d s in c e I
To th e y
not
go
to
a
d e n tu ris t
b e c a u s e d e n t is t s “ d o i t b e t t e r ” is l i k e
re fe rra l
D o n ’t
s e r v ic e — a
w o rry ,
d o c to r,
to ll-fr e e
we
w o n ’t
P e rm a n e n c y o f E B A
cem ent
d o n o t k n o w i f i t is
is o l a t e d o r p a r t o f a la r g e r p r o b l e m ,
p ro fe s
s te a l y o u r p a t i e n t ; y o u c a n h a v e y o u r
I
s io n w i l l n o t b e h e a r d ; t h e y h a v e n o t
3 0 % . J u s t le t th e 7 0 % k n o w th e y d o n ’t
a s t o it s p r e v a l e n c e o r l a c k t h e r e o f .
li s t e n e d t o u s f o r 5 0 y e a r s o r m o r e .
h a v e to s n e a k to a d e n tu ris t; th e y d o
T h e r e is n o e v i d e n c e t h e y w i l l li s t e n
have a
t o u s n o w , o n a lo g ic a l b a s is .
ry .
s h o u t in g
in to
th e
g a le .
The
c h o ic e a n d
so d o e s
d e n tis t
w o u ld
a p p r e c ia te
s o m e res p o n s e s
F o r a t im e in t h e r e c e n t p a s t, I h a d b e e n u s in g a n a l u m i n a E B A
cem ent
t o p e r m a n e n t l y c e m e n t a ll m y f i x e d
N e g a t i v e a t t i t u d e t r a n s c e n d s s o c io
JACK C. COLSON, JR ., DDS
b r id g e w o r k
and
e c o n o m ic b o u n d a r ie s . W h i l e i t is t r u e
BRADEN TON, FLA
d i s c o v e r in g
a
c ro w n s .
I
am
d i s c o n c e r t in g
now
am ount
t h a t m a n y d e n t u r e w e a r e r s a r e s e n io r
o f c e m e n t b r e a k d o w n a n d b r id g e f a i l
c it iz e n s t r y i n g t o s u r v i v e i n a n i n f l a
u r e s . T h e f i r s t o n e o r t w o in s t a n c e s w e re
tio n a r y a g e o n a f ix e d o r lim it e d in c o m e , th e re a re ju s t as m a n y “ C a d il la c s ”
O x id a t io n o f a lu m in u m
lo n g -s p a n
b r id g e s
w h e re
an
a b u t m e n t c r o w n lo o s e n e d o n a t o o t h a d ja c e n t t o a la r g e ( t h r e e o r f o u r u n i t )
in o u r p a r k i n g l o t a s t h e r e a r e m I n t h e M a r c h is s u e o f T h e J o u r n a l ,
p o n t ic a r e a . I a t t r i b u t e d t h is t o p o s
T h e a p p e a l o f t h e d e n t u r i s t is s im
D r s . B e ll, F in n e g a n , a n d W a r d s ta te
s ib le
p l e e c o n o m ic s , a n d t h e m e s s a g e t h e y
o n p a g e 5 1 2 , w i t h r e f e r e n c e t o a lu m
o v e r t h e lo n g e d e n t u l o u s s p a n . T h e n
t e l l is h e a r d a n d li s t e n e d t o b y e v e r y
in u m
som e
p a t ie n t s
one.
I
a d d i t io n a l c o s t , t h e d is a d v a n t a g e s o f
span
b r id g e s
m a d e th e d e n tu re s f o r D r . A . a n y w a y .
a lu m in u m b a s e s a r e d i s c o l o r a t i o n a n d
lo o s e o n o n e o r b o t h a b u t m e n t t e e t h
I c a n s a v e y o u s e v e ra l h u n d r e d d o l
p i t t i n g , w h i c h L u n d q u i s t b e li e v e s a r e
even
th o u g h
a p p e a re d
t r u e in d ig e n t p a t ie n t s .
“ Let me
tre a t y o u
d ir e c tly .
la r s .”
d e n tu re
bases;
“ O th e r
th a n
la c k
o f r ig id ity
o f th e
re tu rn e d (th re e
th e
or
b r id g e
w ith
s h o rt-
fo u r
u n its )
a b u tm e n t p re p a ra
t h e r e s u l t o f e x p o s u r e t o c o m m e r c ia l
t io n s
1 0 0 ,0 0 0
d e n t u r e c le a n e r s . T h e m e t a l lo s e s its
p a r a l l e l s id e d . I e v e n h a d o n e b r id g e
d e n t is t s is in s i g n i f ic a n t i n c o m p a r i s o n
b r ig h t s h in y c o l o r a n d b e c o m e s d u ll
w ith
w i t h th e v o tin g p o w e r o f 7 0 ,0 0 0 ,0 0 0
g r a y .”
b e tw e e n
The
lo b b y i n g
e ffo rts
s e n io r c i t i z e n s . W h o m
of
m u ltip le
lo n g
and
a b u tm e n ts
r e c a ll
re la tiv e ly
in
w h ic h ,
a p p o in t m e n t s ,
one
d o y o u th in k
W h a t t h e w r i t e r s h a v e o b s e r v e d is
a b u tm e n t to o th d e c a y e d a t th e c ro w n
t h e le g is la t o r s w i l l l i s t e n t o ? D e n t u r -
u n d o u b t e d ly n o t t h e r e s u l t o f a c t i o n
m a r g i n s o s e v e r e l y t h a t a c a r io u s p u l p
is m w i l l b e c o m e le g a l i n m a n y s ta te s .
o f c o m m e r c ia l d e n tu re
but
e x p o s u r e a n d p e r i a p i c a l in f e c t i o n o c
th e p r o p e r ty o f a lu m in u m to o x id iz e
c u r r e d e v e n t h o u g h t h e a d ja c e n t a b u t
a lm o s t in s t a n t l y w h e n e x p o s e d t o o x y
m e n t s a n d t h e b r id g e a s a w h o l e a p
gen
p e a re d s e c u re .
T h e r e h a s to b e a n o th e r a p p ro a c h to
th e
p r o b le m .
The
a p p e a l o f th e
d e n tu ris t h a s t o
be
s o lu t io n
e x is t s ;
we
The
in
any
s ta te ,
in c lu d in g
a tm o s
A l l th e s e f a ilu r e s
can put
p h e r ic . T h e o n ly w a y in w h ic h a lu m
by
sup
in u m c a n b e c a u s e d t o r e t a i n m e t a ll ic
tw o
p l y i n g q u a l i t y d e n t u r e s a t e c o n o m ic a l
b r ig h t n e s s m o r e t h a n m o m e n t a r i l y is
E B A c e m e n t.
p r ic e s .
b y p o lis h in g a n d la c q u e r in g w i t h i n a
th e m
a lr e a d y
d e s tro y e d .
c le a n e r s
r ig h t o u t o f b u s in e s s
W e c a n id e n t if y v id u a l s in
15 c lin ic s o r i n d i
F l o r id a th a t o f f e r q u a lity
y e a rs
o c c u rre d w ith in
o f c e m e n ta tio n
W h a t is p a r t i c u l a r l y th a t th e a lu m in a E B A
vacuum . L ith o g ra p h e r s ,
who
fro m
w ith
th e
d i s t r e s s in g is c e m e n ts w e r e
p r in t
a lm o s t
to u te d
a lu m in u m
p la te s ,
o t h e r c e m e n t s . B e f o r e u s in g t h e E B A
as
an
“ im p r o v e m e n t ”
over
d e n t u r e s f o r $ 2 5 0 o r le s s . W e a r e s u r e
e x c lu s iv e ly
t h e r e a r e d o z e n s i f n o t h u n d r e d s in t h e
a r e f u l l y a w a r e o f t h is a lm o s t - in s t a n -
c e m e n t e x te n s iv e ly , I
U n i t e d S t a t e s . W e c a n g i v e t h e p u b li c
t a n e o u s r e a c t i o n . T h e y r e c o g n iz e t h a t
a tw o - d a y s e m in a r g iv e n b y a s u p p o s
had
a tte n d e d
a c h o ic e . A t t h e s a m e o r c o m p a r a b le
t h e y a r e w o r k i n g n o t f r o m a lu m in u m
e d ly r e p u ta b le c lin ic ia n a t w h ic h E B A
p r ic e o ffe r e d b y th e d e n tu ris t, w e c a n
b u t f r o m a v e r y th in s u rfa c e o f a lu m
was
p ro d u c e
in u m o x id e . T h e r e a c t i o n e x t e n d s to
c e m e n t.
th e
m o le c u le s
s iv e a n d t e n s ile s t r e n g t h s w e r e q u o t e d
a n d f o r m s a l a r g e l y i n e r t c o a t in g w h ic h
a n d it s g e n t le n e s s t o t h e p u l p c it e d .
a
q u a lity
d e n tu re ,
and
we
m e a n q u a lity w it h n o s h o rtc u ts . W it h th e p r ic e n o lo n g e r a fa c to r , whom
do
you
th in k
th e p u b lic
w ill
d e p th
o f o n ly
is i m p e r v io u s
to
a fe w
m o s t c h e m ic a ls
as
p r a is e d
as
F ig u r e s
th e
best p e rm a n e n t
as to
it s
c o m p res
W h a t I w o u l d l i k e t o k n o w is , h a v e
LETTERS TO THE EDITOR / JADA, Vol. 95, A ugust 1977 ■ 187
any
lo n g - t e r m
done
c lin i c a l
c o m p a rin g
th e
s tu d ie s
been
p e r io d f o r 2 0 5 f u l l c a s t c ro w n s . A n
a lu m in a
EBA
o th e r
c l i n ic a l
s tu d y 4
has
r e p o rte d
c e m e n t t o t h e o x y p h o s p h a t e a n d car-;
t h a t , i n a t h r e e - y e a r p e r i o d , 1 0 o f 129
b o x y la te c e m e n ts in th e m o u th ? A ls o ,
b r id g e s
am
I
a lo n e
or have
o t h e r s h a d th is
p r o b le m ?
GEORGE SH ILL IN G , DDS SYOSSET, NY E d it o r ’s
n o te : W e
asked
D r.
A b h i j i t A c h a r y a , P h D , a s s is t a n t s e c
re s p o n d
to
■
D r . S h illin g h a s r e p o r te d a n u m b e r
o f cas e s o f c e m e n t fa ilu r e in p e rm a n e n t l u t i n g o f b r id g e s , b o t h s h o r t a n d
m I h a v e r e a d w it h in te r e s t th e a r tic le
r e f l e x i n c o n s c io u s s e d a t i o n ”
T h e c l i n i c a l e v i d e n c e t o d a t e i n d i c a te s
th a t
th e
Z O E -a lu m in a -E B A
in th e
M a y is s u e o f T h e J o u r n a l ( p a g e 9 0 1 ) . I
fe e l th a t th e
c o n c lu s io n s
in
th e
c e m e n t s s h o u ld n o t b e u s e d r o u t i n e l y
a r t i c l e a llu d in g t o in c r e a s e d r is k s o f
fo r
a s p ir a t io n
p e r m a n e n t lu t in g .
s h o u ld j u d g e
te ria ls
to
have
c o m e lo o s e a s c o m p a r e d w i t h 3 o f 120
such
D e v ic e s ,
Z O E -E B A
b r id g e s u s in g z in c - p h o s p h a t e .
tra u m a
and
w ith
e n t i t l e d “ T h e e f f i c a c y o f t h e la r y n g e a l
r e ta r y to th e C o u n c il o n D e n ta l M a
D r . S h illin g ’ s le tte r .
lu t e d
C r it ic iz e s s e d a t io n a r t ic le
as
in
a c tu a l
each or
The
c lin ic ia n
case
p o t e n t ia l
d u rin g
in tra v e n o u s
seda
fa c to rs 5
t i o n b e in g d u e s o le ly t o t h e a d d i t io n
p u lp a l
o f 2 5 m g o f D e m e r o l a re t o ta lly u n
th e
w a r r a n t e d a n d i n c o n c lu s iv e . T h e d e
tr e a t m e n t p r o c e d u r e , th e f i t a n d r e te n
g r e e o f s e d a t i o n a c q u ir e d b y e a c h p a
or
in fla m m a tio n
d u r in g
t iv e n e s s o f t h e c a s t in g a n d t h e p r e p
tie n t w a s n o t m e n tio n e d , w h ic h h a s
a r a t i o n , w h e t h e r t h e lu t in g is m e a n t
fa r
to b e te m p o r a r y o r p e r m a n e n t. T h e
D e m e r o l in o n ly o n e p a tie n t. I w o u ld
Z O E -a lu m in a -E B A
s h o u ld
b e i n t e r e s t e d i n s e e in g a c o n t r o l , s u c h
w h e r e p u lp p r o t e c t i o n is a
as a n e q u a l n u m b e r o f p a t ie n t s h a v in g
c e m e n ts
g re a te r
im p l ic a t i o n s
th a n
u s in g
lo n g s p a n , w i t h i n t w o y e a r s w h e n a
b e used
Z O E -a lu m in a -E B A c e m e n t w as used.
p r im a r y c o n c e rn a n d w h e re th e f it o f
th e s a m e p ro c e d u re s p e rfo rm e d w ith
D r . S h i lli n g w o u l d l i k e t o k n o w :
t h e c a s t in g is o p t im u m .
lo c a l
— w h e th e r lo n g -te r m
c lin ic a l s tu d
ie s h a v e b e e n d o n e o n t h e p e r f o r m a n c e o f th e E B A c e m e n ts in c o m p a r is o n
to
th e
o x y p h o s p h a te
— w h e th e r d iffic u ltie s
o th e rs
w ith
th e
c e m e n ts ?
have
r e p o rte d
EB A
c e m e n ts
s i m i l a r t o t h o s e e x p e r i e n c e d b y h im ? T h e a n s w e rs to b o th th e a b o v e q u es t io n s
a re
a ffir m a tiv e .
The
ZO E-
a lu m in a - E B A c e m e n ts h a v e s tre n g th p r o p e r t ie s
c o m p a r a b le
to
th o s e
of
z i n c p h o s p h a t e c e m e n t s . I n a d d i t io n , t h e E B A c e m e n t s a r e v e r y b e n ig n to th e
p u lp
tis s u e s
and
th u s
a re
p u lp
c o m p a t ib l e i n c a s e s o f n e a r e x p o s u r e o r e x p o s u re o f th e p u lp .1 U n fo r tu n a te ly ,
th e
EB A
c e m e n ts
h a v e p o o r re s is ta n c e to a b ra s io n a n d d i s i n t e g r a t i o n p o s s ib ly d u e t o lo s s o f e u g e n o l t h r o u g h le a c h in g b y o r a l f l u id s .2 I n
tiv e
c a s tin g s
and
L e s s re te n
lo n g - s p a n
b r id g e s
w i ll p r o b a b ly n e e d th e s tre n g th a n d re s is ta n c e
to
d is in te g r a tio n
th a t th e
o n ly .
N o
c o n tro l
W i t h a ll d u e r e s p e c t t o t h e a u t h o r s , I f e e l t h a t t h is a r t i c l e ’ s c o n c lu s i o n is
z in c - p h o s p h a t e c e m e n t s c a n p r o v id e ;
to t a lly
a p u l p - c o m p a t ib le b a s e c a n b e u s e d
s u r g e o n , i n t r a v e n o u s s e d a t i o n is u s e d
in v a lid .
As
a p r a c tic in g o r a l
q u it e f r e q u e n t l y in m y o f f i c e w i t h a
w h e r e in d ic a t e d .
n u m b e r o f a g e n t s a n d c o m b in a t i o n s o f 1. G u ide to Dental M aterials and Devices, ed 8. Council on Dental M aterials and D e
a g e n ts . D e m e r o l, o f c o u rs e , h a s b e e n
vices, A m erican p 145.
n o t e x p e rie n c e d
Dental Association,
1976,
2. Going, R.E., and M itchem , J.C. Cements fo r perm anent luting: a sum m arizing review. JADA 91:107 July 1975. 3. Horn, H.R. Cem entations of crowns and
a f a v o r i t e f o r q u it e a lo n g t i m e . I h a v e a n y p r o b le m s
w ith
a s p ir a tio n , e v e n th o u g h s o m e m a y b e s ile n t .
I
d o fe e l th a t a b e tte r s tu d y
c o u ld h a v e b e e n p e r fo r m e d . I t is e a s y f o r m e t o b e c r i t i c a l o f s u c h
fixed partial dentures, dental cem ents. Dent Clin North Am M arch 1965, p 70.
a s t u d y a s I h a v e n o t d o n e o n e m y s e lf .
4. Silvey, R .G .,a n d Myers, G.E. Prelim inary report of a three-year study of three luting
r e a l l y c o n t r i b u t e t o t h e w e l l b e in g o f
cem ents. M icrofilm ed paper no. 548, Interna tional Association of Dental Research, A t lanta, March 21-24, 1974.
H o w e v e r , I fe e l th e a r tic le d o e s n o t
m y p a t ie n t s
n o r to a n y o th e rs p r a c
t ic in g s u r g e r y .
Dennison, J.D. A
RONALD K. M ICH ELSO N, DDS
review of dental cem ents used fo r perm anent
VIRGINIA BEACH, VA
5. Powers,
J.M .,
and
s p it e o f t h e s e s h o r t c o m in g s ,
retention of restorations. Part 2: properties
a c lin i c a l s t u d y 3 h a s r e p o r t e d n o lo o s
and criteria fo r selection. J Mich Dent Assoc 56:218 July-Aug 1974.
e n in g o f r e s t o r a t io n s o v e r a t w o - y e a r
a n e s t h e s ia
g r o u p is m e n t io n e d i n t h is a r t i c l e .
LETTERS TO THE EDITOR / JADA, Vol. 95, A ugu st 1977 ■ 189
choose
y e a rs .
d e n tu ris t
to
m ake
th e ir
d e n tu re ,
th e
w e ll as h ig h ly re s is ta n t to a b ra s io n .
tw o
I f s c r a t c h e d o r p o lis h e d o f f , i t im m e d
s t a t e t h e p a t ie n t s h a v e n o t s e e n a d e n
y e a r s ’ e x p e r i e n c e , w e a lr e a d y k n o w
ia t e ly fo rm s a n e w a n d id e n tic a l c o a t
t i s t i n 15 t o 2 0 y e a r s . T h i s h o ld s t r u e
th e a n s w e r.
in g u n d e r m o s t c o n d it io n s .
W ith
50%
a c c u ra c y ,
we
can
r e g a r d le s s o f w h e t h e r t h e y a r e e d e n t u lo u s o r n o t .
or
th e
d e n tis t?
W ith
T h e o n l y p r o b l e m is i n f o r m i n g t h e
O LIN E . FREEDM AN
p u b l i c , l e t t i n g t h e m k n o w a n a lt e r n a
CON SU LTANT TO M A NAGEM EN T IN
s u p p o rt
GRAPHICS COM M UNICATIONS
h a v e n o t a c c e p te d th e r h e to r ic o f th e
a n d e n d o rs e th e c o n c e p t o f a c e n tra l
IN D U STR IE S, CHICAGO
d e n ta l
lis t in g w i t h a t o l l - f r e e c o n s u m e r i n f o r
F o r w h a t e v e r r e a s o n , t h e s e p e o p le
p ro fe s s io n .
They
have
not
tiv e
e x is t s .
T h e re fo re ,
we
b ru s h e d a f t e r e v e r y m e a l, th e y h a v e
m a tio n
n o t u s e d d e n t a l f lo s s , a n d t h e y h a v e
p h o n e n u m b e r a p e rs o n c a n c a ll t o f in d
n o t s e e n t h e ir d e n tis t t w ic e
a y e a r.
o u t t h e i n d iv id u a ls o r c lin ic s n e a r h i m
t e l l t h i s s a m e g r o u p o f p e o p le
th a t p r o d u c e q u a lity d e n tu re s a t e c o n
■ I a m h a v in g a p r o b le m in m y p r a c
s h o u ld
o m ic a l p r ic e s .
t ic e a n d s in c e I
To th e y
not
go
to
a
d e n tu ris t
b e c a u s e d e n t is t s “ d o i t b e t t e r ” is l i k e
re fe rra l
D o n ’t
s e r v ic e — a
w o rry ,
d o c to r,
to ll-fr e e
we
w o n ’t
P e rm a n e n c y o f E B A
cem ent
d o n o t k n o w i f i t is
is o l a t e d o r p a r t o f a la r g e r p r o b l e m ,
p ro fe s
s te a l y o u r p a t i e n t ; y o u c a n h a v e y o u r
I
s io n w i l l n o t b e h e a r d ; t h e y h a v e n o t
3 0 % . J u s t le t th e 7 0 % k n o w th e y d o n ’t
a s t o it s p r e v a l e n c e o r l a c k t h e r e o f .
li s t e n e d t o u s f o r 5 0 y e a r s o r m o r e .
h a v e to s n e a k to a d e n tu ris t; th e y d o
T h e r e is n o e v i d e n c e t h e y w i l l li s t e n
have a
t o u s n o w , o n a lo g ic a l b a s is .
ry .
s h o u t in g
in to
th e
g a le .
The
c h o ic e a n d
so d o e s
d e n tis t
w o u ld
a p p r e c ia te
s o m e res p o n s e s
F o r a t im e in t h e r e c e n t p a s t, I h a d b e e n u s in g a n a l u m i n a E B A
cem ent
t o p e r m a n e n t l y c e m e n t a ll m y f i x e d
N e g a t i v e a t t i t u d e t r a n s c e n d s s o c io
JACK C. COLSON, JR ., DDS
b r id g e w o r k
and
e c o n o m ic b o u n d a r ie s . W h i l e i t is t r u e
BRADEN TON, FLA
d i s c o v e r in g
a
c ro w n s .
I
am
d i s c o n c e r t in g
now
am ount
t h a t m a n y d e n t u r e w e a r e r s a r e s e n io r
o f c e m e n t b r e a k d o w n a n d b r id g e f a i l
c it iz e n s t r y i n g t o s u r v i v e i n a n i n f l a
u r e s . T h e f i r s t o n e o r t w o in s t a n c e s w e re
tio n a r y a g e o n a f ix e d o r lim it e d in c o m e , th e re a re ju s t as m a n y “ C a d il la c s ”
O x id a t io n o f a lu m in u m
lo n g -s p a n
b r id g e s
w h e re
an
a b u t m e n t c r o w n lo o s e n e d o n a t o o t h a d ja c e n t t o a la r g e ( t h r e e o r f o u r u n i t )
in o u r p a r k i n g l o t a s t h e r e a r e m I n t h e M a r c h is s u e o f T h e J o u r n a l ,
p o n t ic a r e a . I a t t r i b u t e d t h is t o p o s
T h e a p p e a l o f t h e d e n t u r i s t is s im
D r s . B e ll, F in n e g a n , a n d W a r d s ta te
s ib le
p l e e c o n o m ic s , a n d t h e m e s s a g e t h e y
o n p a g e 5 1 2 , w i t h r e f e r e n c e t o a lu m
o v e r t h e lo n g e d e n t u l o u s s p a n . T h e n
t e l l is h e a r d a n d li s t e n e d t o b y e v e r y
in u m
som e
p a t ie n t s
one.
I
a d d i t io n a l c o s t , t h e d is a d v a n t a g e s o f
span
b r id g e s
m a d e th e d e n tu re s f o r D r . A . a n y w a y .
a lu m in u m b a s e s a r e d i s c o l o r a t i o n a n d
lo o s e o n o n e o r b o t h a b u t m e n t t e e t h
I c a n s a v e y o u s e v e ra l h u n d r e d d o l
p i t t i n g , w h i c h L u n d q u i s t b e li e v e s a r e
even
th o u g h
a p p e a re d
t r u e in d ig e n t p a t ie n t s .
“ Let me
tre a t y o u
d ir e c tly .
la r s .”
d e n tu re
bases;
“ O th e r
th a n
la c k
o f r ig id ity
o f th e
re tu rn e d (th re e
th e
or
b r id g e
w ith
s h o rt-
fo u r
u n its )
a b u tm e n t p re p a ra
t h e r e s u l t o f e x p o s u r e t o c o m m e r c ia l
t io n s
1 0 0 ,0 0 0
d e n t u r e c le a n e r s . T h e m e t a l lo s e s its
p a r a l l e l s id e d . I e v e n h a d o n e b r id g e
d e n t is t s is in s i g n i f ic a n t i n c o m p a r i s o n
b r ig h t s h in y c o l o r a n d b e c o m e s d u ll
w ith
w i t h th e v o tin g p o w e r o f 7 0 ,0 0 0 ,0 0 0
g r a y .”
b e tw e e n
The
lo b b y i n g
e ffo rts
s e n io r c i t i z e n s . W h o m
of
m u ltip le
lo n g
and
a b u tm e n ts
r e c a ll
re la tiv e ly
in
w h ic h ,
a p p o in t m e n t s ,
one
d o y o u th in k
W h a t t h e w r i t e r s h a v e o b s e r v e d is
a b u tm e n t to o th d e c a y e d a t th e c ro w n
t h e le g is la t o r s w i l l l i s t e n t o ? D e n t u r -
u n d o u b t e d ly n o t t h e r e s u l t o f a c t i o n
m a r g i n s o s e v e r e l y t h a t a c a r io u s p u l p
is m w i l l b e c o m e le g a l i n m a n y s ta te s .
o f c o m m e r c ia l d e n tu re
but
e x p o s u r e a n d p e r i a p i c a l in f e c t i o n o c
th e p r o p e r ty o f a lu m in u m to o x id iz e
c u r r e d e v e n t h o u g h t h e a d ja c e n t a b u t
a lm o s t in s t a n t l y w h e n e x p o s e d t o o x y
m e n t s a n d t h e b r id g e a s a w h o l e a p
gen
p e a re d s e c u re .
T h e r e h a s to b e a n o th e r a p p ro a c h to
th e
p r o b le m .
The
a p p e a l o f th e
d e n tu ris t h a s t o
be
s o lu t io n
e x is t s ;
we
The
in
any
s ta te ,
in c lu d in g
a tm o s
A l l th e s e f a ilu r e s
can put
p h e r ic . T h e o n ly w a y in w h ic h a lu m
by
sup
in u m c a n b e c a u s e d t o r e t a i n m e t a ll ic
tw o
p l y i n g q u a l i t y d e n t u r e s a t e c o n o m ic a l
b r ig h t n e s s m o r e t h a n m o m e n t a r i l y is
E B A c e m e n t.
p r ic e s .
b y p o lis h in g a n d la c q u e r in g w i t h i n a
th e m
a lr e a d y
d e s tro y e d .
c le a n e r s
r ig h t o u t o f b u s in e s s
W e c a n id e n t if y v id u a l s in
15 c lin ic s o r i n d i
F l o r id a th a t o f f e r q u a lity
y e a rs
o c c u rre d w ith in
o f c e m e n ta tio n
W h a t is p a r t i c u l a r l y th a t th e a lu m in a E B A
vacuum . L ith o g ra p h e r s ,
who
fro m
w ith
th e
d i s t r e s s in g is c e m e n ts w e r e
p r in t
a lm o s t
to u te d
a lu m in u m
p la te s ,
o t h e r c e m e n t s . B e f o r e u s in g t h e E B A
as
an
“ im p r o v e m e n t ”
over
d e n t u r e s f o r $ 2 5 0 o r le s s . W e a r e s u r e
e x c lu s iv e ly
t h e r e a r e d o z e n s i f n o t h u n d r e d s in t h e
a r e f u l l y a w a r e o f t h is a lm o s t - in s t a n -
c e m e n t e x te n s iv e ly , I
U n i t e d S t a t e s . W e c a n g i v e t h e p u b li c
t a n e o u s r e a c t i o n . T h e y r e c o g n iz e t h a t
a tw o - d a y s e m in a r g iv e n b y a s u p p o s
had
a tte n d e d
a c h o ic e . A t t h e s a m e o r c o m p a r a b le
t h e y a r e w o r k i n g n o t f r o m a lu m in u m
e d ly r e p u ta b le c lin ic ia n a t w h ic h E B A
p r ic e o ffe r e d b y th e d e n tu ris t, w e c a n
b u t f r o m a v e r y th in s u rfa c e o f a lu m
was
p ro d u c e
in u m o x id e . T h e r e a c t i o n e x t e n d s to
c e m e n t.
th e
m o le c u le s
s iv e a n d t e n s ile s t r e n g t h s w e r e q u o t e d
a n d f o r m s a l a r g e l y i n e r t c o a t in g w h ic h
a n d it s g e n t le n e s s t o t h e p u l p c it e d .
a
q u a lity
d e n tu re ,
and
we
m e a n q u a lity w it h n o s h o rtc u ts . W it h th e p r ic e n o lo n g e r a fa c to r , whom
do
you
th in k
th e p u b lic
w ill
d e p th
o f o n ly
is i m p e r v io u s
to
a fe w
m o s t c h e m ic a ls
as
p r a is e d
as
F ig u r e s
th e
best p e rm a n e n t
as to
it s
c o m p res
W h a t I w o u l d l i k e t o k n o w is , h a v e
LETTERS TO THE EDITOR / JADA, Vol. 95, A ugust 1977 ■ 187
any
lo n g - t e r m
done
c lin i c a l
c o m p a rin g
th e
s tu d ie s
been
p e r io d f o r 2 0 5 f u l l c a s t c ro w n s . A n
a lu m in a
EBA
o th e r
c l i n ic a l
s tu d y 4
has
r e p o rte d
c e m e n t t o t h e o x y p h o s p h a t e a n d car-;
t h a t , i n a t h r e e - y e a r p e r i o d , 1 0 o f 129
b o x y la te c e m e n ts in th e m o u th ? A ls o ,
b r id g e s
am
I
a lo n e
or have
o t h e r s h a d th is
p r o b le m ?
GEORGE SH ILL IN G , DDS SYOSSET, NY E d it o r ’s
n o te : W e
asked
D r.
A b h i j i t A c h a r y a , P h D , a s s is t a n t s e c
re s p o n d
to
■
D r . S h illin g h a s r e p o r te d a n u m b e r
o f cas e s o f c e m e n t fa ilu r e in p e rm a n e n t l u t i n g o f b r id g e s , b o t h s h o r t a n d
m I h a v e r e a d w it h in te r e s t th e a r tic le
r e f l e x i n c o n s c io u s s e d a t i o n ”
T h e c l i n i c a l e v i d e n c e t o d a t e i n d i c a te s
th a t
th e
Z O E -a lu m in a -E B A
in th e
M a y is s u e o f T h e J o u r n a l ( p a g e 9 0 1 ) . I
fe e l th a t th e
c o n c lu s io n s
in
th e
c e m e n t s s h o u ld n o t b e u s e d r o u t i n e l y
a r t i c l e a llu d in g t o in c r e a s e d r is k s o f
fo r
a s p ir a t io n
p e r m a n e n t lu t in g .
s h o u ld j u d g e
te ria ls
to
have
c o m e lo o s e a s c o m p a r e d w i t h 3 o f 120
such
D e v ic e s ,
Z O E -E B A
b r id g e s u s in g z in c - p h o s p h a t e .
tra u m a
and
w ith
e n t i t l e d “ T h e e f f i c a c y o f t h e la r y n g e a l
r e ta r y to th e C o u n c il o n D e n ta l M a
D r . S h illin g ’ s le tte r .
lu t e d
C r it ic iz e s s e d a t io n a r t ic le
as
in
a c tu a l
each or
The
c lin ic ia n
case
p o t e n t ia l
d u rin g
in tra v e n o u s
seda
fa c to rs 5
t i o n b e in g d u e s o le ly t o t h e a d d i t io n
p u lp a l
o f 2 5 m g o f D e m e r o l a re t o ta lly u n
th e
w a r r a n t e d a n d i n c o n c lu s iv e . T h e d e
tr e a t m e n t p r o c e d u r e , th e f i t a n d r e te n
g r e e o f s e d a t i o n a c q u ir e d b y e a c h p a
or
in fla m m a tio n
d u r in g
t iv e n e s s o f t h e c a s t in g a n d t h e p r e p
tie n t w a s n o t m e n tio n e d , w h ic h h a s
a r a t i o n , w h e t h e r t h e lu t in g is m e a n t
fa r
to b e te m p o r a r y o r p e r m a n e n t. T h e
D e m e r o l in o n ly o n e p a tie n t. I w o u ld
Z O E -a lu m in a -E B A
s h o u ld
b e i n t e r e s t e d i n s e e in g a c o n t r o l , s u c h
w h e r e p u lp p r o t e c t i o n is a
as a n e q u a l n u m b e r o f p a t ie n t s h a v in g
c e m e n ts
g re a te r
im p l ic a t i o n s
th a n
u s in g
lo n g s p a n , w i t h i n t w o y e a r s w h e n a
b e used
Z O E -a lu m in a -E B A c e m e n t w as used.
p r im a r y c o n c e rn a n d w h e re th e f it o f
th e s a m e p ro c e d u re s p e rfo rm e d w ith
D r . S h i lli n g w o u l d l i k e t o k n o w :
t h e c a s t in g is o p t im u m .
lo c a l
— w h e th e r lo n g -te r m
c lin ic a l s tu d
ie s h a v e b e e n d o n e o n t h e p e r f o r m a n c e o f th e E B A c e m e n ts in c o m p a r is o n
to
th e
o x y p h o s p h a te
— w h e th e r d iffic u ltie s
o th e rs
w ith
th e
c e m e n ts ?
have
r e p o rte d
EB A
c e m e n ts
s i m i l a r t o t h o s e e x p e r i e n c e d b y h im ? T h e a n s w e rs to b o th th e a b o v e q u es t io n s
a re
a ffir m a tiv e .
The
ZO E-
a lu m in a - E B A c e m e n ts h a v e s tre n g th p r o p e r t ie s
c o m p a r a b le
to
th o s e
of
z i n c p h o s p h a t e c e m e n t s . I n a d d i t io n , t h e E B A c e m e n t s a r e v e r y b e n ig n to th e
p u lp
tis s u e s
and
th u s
a re
p u lp
c o m p a t ib l e i n c a s e s o f n e a r e x p o s u r e o r e x p o s u re o f th e p u lp .1 U n fo r tu n a te ly ,
th e
EB A
c e m e n ts
h a v e p o o r re s is ta n c e to a b ra s io n a n d d i s i n t e g r a t i o n p o s s ib ly d u e t o lo s s o f e u g e n o l t h r o u g h le a c h in g b y o r a l f l u id s .2 I n
tiv e
c a s tin g s
and
L e s s re te n
lo n g - s p a n
b r id g e s
w i ll p r o b a b ly n e e d th e s tre n g th a n d re s is ta n c e
to
d is in te g r a tio n
th a t th e
o n ly .
N o
c o n tro l
W i t h a ll d u e r e s p e c t t o t h e a u t h o r s , I f e e l t h a t t h is a r t i c l e ’ s c o n c lu s i o n is
z in c - p h o s p h a t e c e m e n t s c a n p r o v id e ;
to t a lly
a p u l p - c o m p a t ib le b a s e c a n b e u s e d
s u r g e o n , i n t r a v e n o u s s e d a t i o n is u s e d
in v a lid .
As
a p r a c tic in g o r a l
q u it e f r e q u e n t l y in m y o f f i c e w i t h a
w h e r e in d ic a t e d .
n u m b e r o f a g e n t s a n d c o m b in a t i o n s o f 1. G u ide to Dental M aterials and Devices, ed 8. Council on Dental M aterials and D e
a g e n ts . D e m e r o l, o f c o u rs e , h a s b e e n
vices, A m erican p 145.
n o t e x p e rie n c e d
Dental Association,
1976,
2. Going, R.E., and M itchem , J.C. Cements fo r perm anent luting: a sum m arizing review. JADA 91:107 July 1975. 3. Horn, H.R. Cem entations of crowns and
a f a v o r i t e f o r q u it e a lo n g t i m e . I h a v e a n y p r o b le m s
w ith
a s p ir a tio n , e v e n th o u g h s o m e m a y b e s ile n t .
I
d o fe e l th a t a b e tte r s tu d y
c o u ld h a v e b e e n p e r fo r m e d . I t is e a s y f o r m e t o b e c r i t i c a l o f s u c h
fixed partial dentures, dental cem ents. Dent Clin North Am M arch 1965, p 70.
a s t u d y a s I h a v e n o t d o n e o n e m y s e lf .
4. Silvey, R .G .,a n d Myers, G.E. Prelim inary report of a three-year study of three luting
r e a l l y c o n t r i b u t e t o t h e w e l l b e in g o f
cem ents. M icrofilm ed paper no. 548, Interna tional Association of Dental Research, A t lanta, March 21-24, 1974.
H o w e v e r , I fe e l th e a r tic le d o e s n o t
m y p a t ie n t s
n o r to a n y o th e rs p r a c
t ic in g s u r g e r y .
Dennison, J.D. A
RONALD K. M ICH ELSO N, DDS
review of dental cem ents used fo r perm anent
VIRGINIA BEACH, VA
5. Powers,
J.M .,
and
s p it e o f t h e s e s h o r t c o m in g s ,
retention of restorations. Part 2: properties
a c lin i c a l s t u d y 3 h a s r e p o r t e d n o lo o s
and criteria fo r selection. J Mich Dent Assoc 56:218 July-Aug 1974.
e n in g o f r e s t o r a t io n s o v e r a t w o - y e a r
a n e s t h e s ia
g r o u p is m e n t io n e d i n t h is a r t i c l e .
LETTERS TO THE EDITOR / JADA, Vol. 95, A ugu st 1977 ■ 189