REVIEW: This is what makes Doxa's Ceramir® Crown and Bridge different

Catapult was asked to review Doxa’s new cement, Ceramir, and the question was: Is this cement different?

For half the group the answer was overwhelmingly “yes.” The remainder of the group truly appreciated how easy the cement was to use and its physical properties but had issues with the delivery system because it requires a triturator.

Why a triturator?
With today’s easy-to-use delivery systems that include clicker systems, paste packs and dual barrel syringes, the question becomes why would you need a triturator?

The answer truly is contained in the capsule and its unique calcium based reaction that requires both an activation of 2-3 seconds along with a subsequent 10-second trituration. Is this a deal breaker? If you don’t have a triturator, you may miss out on a game changing product that fulfills the above list of properties for an ideal cement. The vast majority of dentists own triturators and this simply gives us another indication for use.

What it does
Once you get past the fact that you need a triturator, the question is, can a new chemistry in dentistry revolutionize the cement market? The answer is maybe yes! Doxa has now published 2-year data and has 3-year data confirming there is no loss of retention, no secondary caries, no marginal discolorations and no subjective sensitivity.

The material itself hardens through a mechanism of dissolution and re-precipitation, where nano-crystals are built and are bonded to each other. This hardening process allows the material to seal at the tooth’s interface and further build hydroxyapatite in proximity of the dentin interface. This inherently makes this material bioactive.

The process involves the dissolution of water after the activation of the capsule and trituration, causing a reprecipitation where particles in nanometer sizes are built and bond upon each other and create a basic pH. As the material dissolves it wets the tooth and then as the nano-crystals begin to form they precipitate on the tooth surface and upon other crystals. Within minutes the hardening mechanism begins creating a dual functional result: sealing the interface and creating the conditions necessary at the interface of building hydroxyapatite. In essence, its adhesion to the tooth takes the same form as its infrastructure. Another important feature of this cement is that when the powder is dissolved, hydroxide ions are released, creating a basic pH. This higher pH is critical on many fronts because it not only creates an environment conducive to growing hydroxyapatite but it also stabilizes the hydroxyapatite (hydroxyapatite breaks down with acid). Long term, this means it’s caries resistant.

Ceramir Crown and Bridge
Ceramir Crown and Bridge is a bioceramic dental cement for permanent cementation of conventional prosthetics, including all-ceramic constructions with frames of aluminum oxide or zirconium dioxide (alumina and zirconia). This cement is easy to use, provides stable sealing of the prepared tooth, good retention and is tissue and environmentally friendly.
Doxa

You’ve prepared your crown, you’ve removed your temporary, adjusted any minor occlusal and contact issues and now you are ready to cement your restoration. So the key question is, what are you looking for in your cement? The answer is universal and covers the following:

• Long-term permanent seal, i.e. long-term stability and minimal degradation

• Inhibit caries and plaque

• No microleakage

• Biocompatible both internally and externally

• Low solubility

• Strong physical properties such as flexural and compressive strengths

• Thin film thickness

• Universal usage for all ceramic and metal crowns

• Good working and setting times both for single and multiple units

• High retention

• Easy cleanup

• Long-term studies

What evaluators looked for

• 36% of reviewers said thixotropic working property is one of the most important cement characteristics, while 21%  listed working time as most important

• Setting time was most important to 27% of reviewers

• 80% of reviewers said easy excess cement removal and cleanup are important, while 60% believe film thickness is one of the most important characteristics

• 86% listed marginal integrity as one of the most important characteristics, while 47% are most concerned with physical properties

• Only 7% listed odor as one of the most important characteristics, while 36% listed the delivery system

Why you should have it in your practice
With all this said, let’s bring this down to earth and truly explain how this may be a game changer in the cement category. Once the internal surfaces of all zirconia crowns, zirconia to porcelain, gold, porcelain fused to metal and lithium disilicate (prepared via the guidelines of e.max) crowns are all cleaned in the proper way, this cement can be used for all of the above.

Yes, this makes it a universal posterior cement with the exception of ceramic inlays and onlays. I also have used this material for anterior restorations fabricated out of zirconia to porcelain, e.max and porcelain to metal restorations. The exceptions in the anterior category are veneers, Empress and feldspathic crowns that require adhesion support.

After placing this cement into the mouth and waiting 3 minutes, cleanup is as easy as any resin-ionmer cement. Seating multiple crowns (all at once) is equally easy and the capsules come in single dose and multiple dose (up to 3 crowns). It’s also very thin, 15 microns, and makes for a wonderful implant cement because it is tissue biocompatible, which becomes very important because peri-implantitis is often the result of excess cement that is NOT biocompatible.

It works
I have cemented more than 250 units with this material and the Catapult reviewers have cemented more than 1,000 units in the past 8 months. I personally have had one recementation on a minimally retentive prep with an all zirconia crown. Beyond that, patients report minimal to no sensitivity upon placement. The Catapult Group, beyond the need for a triturator, was very excited about the technology in Doxa’s Ceramir cement.