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September 2011
Volume 32, Issue 7

Doxa Dental's Ceramir: A Kinder and Gentler Cement

Doxa Dental, Inc., the recently launched United States branch of the Swedish-based dental products company Doxa AB, is a unique company in its mission to revolutionize dental products by making them more stable over time in the oral environment and more biocompatible. Doxa's first biocompatible product, the Ceramir® Crown & Bridge, an alkaline bioceramic luting cement used for applications such as the permanent fixture of dental crowns, bridges, inlays and onlays, launched in Sweden in November of 2009. The Ceramir Crown & Bridge is the first in a proposed line of dental products with a biocompatibility-based chemistry, and Ceramir's standout qualities have Emil Abrahamsson, President of Doxa Dental Inc., excited about the future of the company.

"Ceramir is a dental bioceramic technology based on biological principles developed methodically in Sweden over the last 25 years," says Abrahamsson, who claims that the chemistry of Ceramir's materials results in long-term superior sealing properties and biocompatibility. Ceramir mimics natural teeth in that it is designed, to the greatest extent possible, to have natural thermal characteristics. Ceramir has low thermal conductivity, like teeth, and "moves" in almost the same way as enamel and dentine. This minimizes the risk of thermal shock when the material is subject to sudden temperature change.

Product Manager Kelley Reinfelds says the most unique aspect of the chemistry of Ceramir is that its material is alkaline, and she explains that the product "bonds to the tooth in the same way as when the tooth remineralizes, so that, rather than degrade, the cement improves in the mouth."

Ceramir was designed to be stored and used within the mouth's naturally wet environment, and Reinfelds remarks that due to its "distinctive" consistency, "Ceramir enables placement of a crown without resistance, even if the fit is tight and the prepared tooth/abutment is parallel." She references a letter from a clinician, who used the product for a high noble metal ceramic crown on a custom milled implant abutment that was "very retentive" because it had "very parallel walls and grooves." However, he wrote, when using the product, "It was easy to seat the restoration during cementation."

Another letter shared from a satisfied Ceramir Crown & Bridge user offered a definition of "the ideal cement" as follows: "The ideal cement is viscous enough to allow the crown/bridge to be held upside down, but at the same time allows for the crown to be seated without any viscoelastic resistance," and cited Ceramir as fulfilling all of said requirements.

Doxa is aiming to solve problems with existing dental cements. In the company's home country of Sweden, recementing constitutes about 15% of all cement treatments, due to problems such as loosening of a crown or veneers. It was estimated that about 70,000 remounting procedures are done in Sweden per year. These numbers led Doxa to search for more effective alternatives to regular cement.

Describing the special characteristics of Ceramir in terms of implant retention and strength, Reinfelds says, "Retention values and compressive strengths are equivalent to or better than self-adhesive resin-based cements. This, she says, is due to the previously mentioned advantages of using a material that does not degrade in the oral environment. "This increases the predictability of successful treatment result over time."

In addition to Ceramir's superior bonding abilities, Reinfelds mentions that there is "incredibly positive clinician feedback related to the exceptional handling characteristics and the total lack of postoperative sensitivity" when compared to other cements. "The material is kinder to the pulp than other dental materials that harden in the mouth, and the chemistry does not cause postoperative sensitivity," says Reinfelds.

During implant therapy, Reinfelds claims that the product's tissue-friendliness is very beneficial. "Because it is so biocompatible and causes no irritation and inflammation, it is safe to use when cementing subgingivally," she says, adding that "multiple independent biocompatibility studies, cytotoxicity studies, and histology studies have proven how gentle this cement is to living tissues." Furthermore, she says, the cement is highly visible on a radiograph because it is radiopaque, making it easy to detect and remove excess cement, thus avoiding future problems such as inflammation, infection, and even implant failure. She compares removal of the product as "almost like removing a rubber band" during what she calls the "rubbery gel-phase."

Doxa has been recognized by dental organizations for its efforts to create a stronger, more biocompatible dental cement with long-term superior sealing properties. In May of 2010, Ceramir Crown & Bridge received Frost & Sullivan's "New Product Innovation Award," and earlier this year Doxa signed an exclusive global distribution agreement with Henry Schein®, Inc. A global consultancy, Frost & Sullivan, which acknowledges products/companies where outstanding achievements have been attained within product development, technological growth, leadership, and service, explained that Ceramir Crown & Bridge is the result of Doxa's leading-edge technology within the realm of new dental care products.

Abrahamsson says four other Doxa products based on bioceramic technology are currently in development and will be on the market sometime in the future. He adds, "We will continue to work to minimize the risks and increase the success rate in the treatments by launching new easy-to-use bioceramic products based strictly on biological principles."

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