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INTRODUCTION

The term cement has been applied to powder / liquid materials which are mixed to a paste
consistency.
The word luting is defined as the use of a moldable substance to seal joints and cement
two substances together.
Various cements are used for luting for example zinc phosphate, zinc silicophosphate,
zinc polycarboxylate, glass ionomer, and zinc oxide eugenol and resin cements.
The clinical success of fixed prosthesis is heavily dependant on the cementation process.
For a restoration to accomplish its purpose, it must stay in place on the tooth. No cements
that are compatible with living tooth structure and the biologic environment of the oral
cavity possess adequate adhesive properties to hold a restoration in place solely through
adhesion.
Although the establishment of optimal resistance and retention forms in the tooth
preparation are of primary importance, a dental cement must be used as a barrier against
microbial leakage, sealing the interface between the tooth and restoration and holding
them together through some form of surface attachment.

PRINCIPLES OF CEMENTATION
Dental treatments necessitate attachment of indirect restorations and appliances to
the teeth by means of a cement. These include metal, resin, metal-resin, metal ceramic,
and ceramic restorations, provisional or interim restorations; laminate veneers for anterior
teeth; orthodontic appliances, and pins and posts used for retention of restorations. The
word luting is often used to describe the use of a moldable substance to seal a space or to
cement two components together;.
The properties of various cements differ from each other. Hence, the choice cement is
mandated to a large degree by the functional and biologic demands of the particular
clinical situation. If optimal performance is to be attained, the physical and biologic
properties, and the handling characteristic, such as the working and setting times and ease
of removing excess materials, must be considered in selecting a cement for a specific
task.
CHARACTERISTICS OF ABUTMENT PROSTHESIS INTERFACE.
When two relatively flat surfaces are brought into contact, analogous to a fixed
prosthesis being placed on a prepared tooth, a space exists between the substrates on a
microscopic scale.
Typical prepared surfaces on a microscopic scale are rough, that is, there are
peaks and valleys. When two surfaces are placed against each other, there are only point
contacts along the peaks. The areas that are not in contact then become open space. The
space created is substantial in terms of oral fluid flow and bacterial invasion. One of the
main purposes of a cement is to fill this space completely. One can seal the space by
placing a soft material, such as an elastomer, between the two surfaces that can conform
under pressure to the roughness.
The current approach is to use the technology of adhesives. Adhesive bonding
involves the placement of a third material, often called a cement that flows within the
rough surface and sets to a solid form within a few minutes. The solid matter not only
seals the space but also retains the prosthesis. Materials used for this application are
classified as Type I cements. If the third material is not fluid enough or is incompatible

with the surfaces, voids can develop around deep, narrow valleys and undermine the
effectiveness of the cement.
BONDING MECHANISM

Non adhesive luting


Originally the luting agent served primarily to fill the gap and prevent entrance of fluids.
Zinc phosphate for example exhibits no adhesion on the molecular level. It holds the
restoration in place by engaging small irregularities on the surface of both tooth and the
restoration. The nearly parallel opposing walls of a correctly prepared tooth make it
impossible to remove the restoration without shearing or crushing the minute projections
of cement extending into recesses in the surfaces.

Micromechanical bonding
Resin cements have tensile strengths in the range of 30 -40 MPa, which is approximately
five times that of zinc phosphate cement. When used on pitted surfaces, they can provide
effective micromechanical bonding. The tensile strengths of such bonds can sometimes
exceed the cohesive strength of enamel. This allows the use of less extensive tooth
preparation for restorations such as ceramic veneers and resin bonded fixed partial
dentures.
The deep irregularities necessary for micromechanical bonding can be produced on
enamel surfaces by etching with phosphoric acid solution or gel, on ceramics by etching
with hydrofluoric acid and on metals by electrolytic etching, chemical etching,
sandblasting or by incorporating salt crystals into preliminary resin pattern.

Molecular Adhesion
Molecular Adhesion involves physical forces (bipolar, Vander Waals) and chemical bonds
(ionic and covalent) between molecules of two different substances. Newer cements, such
as polycarboxylate and glass ionomers, possess some adhesive capabilities, although this
is limited by their relatively low cohesive strength. They still depend primarily on nearly
parallel walls in the preparation to retain restorations.

Limited success has been achieved in attempts to develop resin cements and coupling
agents that will exhibit strong, durable molecular adhesion to tooth structure, base metals
and ceramics. Noble metal alloys are not suited for direct molecular bonding. However, a
thin layer of silane can be bonded to a gold alloy with special equipment (Silicoater,
Kulzer, Irvine or Rocatec, ESPE-Premier) to serve as a coupling agent by bonding
chemically to resin cements. Equally effective is a layer of tin electroplated onto gold
alloy.
By applying a silane coupler to roughened porcelain, shear bond strengths in excess of
the cohesive strength of the porcelain have been achieved. However such bonds tend to
become weaker after thermo cycling in water. At this time, molecular adhesion should be
looked upon only as a way to enhance mechanical and micromechanical retention and
reduce micro leakage, rather than as an independent bonding mechanism.

DISLODGEMENT OF PROSTHESIS
Fixed prostheses can debond because of biologic or physical reasons or a
combination of the two. Recurrent caries results from a biologic origin. Disintegration of
the cements can result from fracture or erosion of the cement. For brittle prostheses, such
as glass-ceramic crowns, fracture of the prosthesis also occurs because of physical
factors, including intraoral forces, flaws within the crown surfaces, and voids within the
cement layer.
In the oral environment cementation agents are immersed in an aqueous solution. In this
environment the cement layer near the margin can dissolve and erode leaving a space.
This space can be susceptible to plaque accumulation and recurrent caries; therefore, the
margin should be protected with a coating (if possible) to allow continuous setting of the
cement.
There are two basic modes of failure associated with cements: cohesive fracture of the
cement and separation along the interfaces. Because the cement layer is the weakest link
of the entire assembly, one should favor higher strength cements to enhance retention and
prevent prosthesis dislodgement by providing a firm support base against applied forces.
Several factors have an influence on the retention of these fixed prostheses.
First, the film thickness beneath the prosthesis should be thin. It is believed that a thinner
film has fewer internal flaws compared with a thicker one.
Second, the cement should have high strength values. Generally, greater forces are
required to dislodge appliances cemented with cements that have higher tensile strength
than with cements of low tensile strength. It is also well established that the stresses
developed during mastication are exceedingly complex. Undoubtedly, properties other
than tensile strength may be involved. These include compressive and shear strength of
the cement, fracture toughness, and film thickness.
Third, the dimensional changes occurring in the cement during setting should be
minimized. Sources include gain or loss of water and differences in the coefficients of
thermal expansion among the tooth, the prosthesis, and the cement.
It is, therefore, important to isolate the cement immediately after removal of the excess.
Fourth, a cement with the potential of chemically bonding to the tooth and prosthetic

surfaces or bond- enhancing intermediate layers may be used to reduce the potential of
separation at the interface and maximize the effect of the inherent strength on the
retention.
When a mechanical undercut is the mechanism of retention, the failure often
occurs along the interfaces. If chemical bonding is involved, the failure often occurs
cohesively through the cement itself. The prosthesis becomes loose only when the cement
fractures or dissolves.
IDEAL PROPERTIES OF LUTING CEMENT
Described by McLean and Wilson
1. Low viscosity and film thickness
2. Long working time with rapid set at mouth temperature
3. Good resistance to aqueous or acid attack
4. High compressive and tensile strength
5. Resistance to plastic deformation
6. Adhesion to tooth structure and restoration
7. Cariostatic
8. Biologically compatible with pulp
9. Translucency
10. Radio opacity

CHOICE OF LUTING AGENT


An ideal luting agent is one which has a long working time, adheres well to both
tooth structure and cast alloys, provides a good seal, is non toxic to pulp, has adequate
strength properties, is compressible into thin layers, has a low viscosity and solubility and
exhibits good working and setting characteristics. In addition any excess can be easily
removed. Unfortunately, no such product exists.

Zinc phosphate cement


Is probably still the luting agent of choice. Cavity varnish can be used to protect
against pulp irritation from phosphoric acid and appears to have little effect on the
amount of retention of the cemented restoration.

Zinc polycarboxylate cement


This agent is recommended on retentive preparation when minimal pulp irritation
is important.

Glass ionomer cement


This has become a popular cement for luting cast restoration. It has good working
properties and because of its fluoride content, it may prevent recurrent caries.

Resin modified glass ionomer cement


Currently among the most popular luting agents, Resin modified glass ionomer
cements have low solubility, adhesion and low micro leakage. The popularity it
mainly due to perceived benefit of reduced post cementation sensitivity.

Adhesive resin
Long-term evaluations of these materials are not yet available, so they cannot be
recommended for routine use. Laboratory testing yields high retention strength values,
but there is concern that stresses caused by polymerization shrinkage, magnified in thin
films, leads to marginal leakage. Adhesive resin may be indicated when a casting has
become displaced through lack of retention.

ZINC PHOSPHATE CEMENT


Zinc phosphate cement is the oldest of the cementation agents and thus has the longest
track record. It serves as a standard by which newer systems can be compared. It is a
traditional crown and bridge cement used for the alloy restorations. It is supplied as a
powder and liquid, both of which are carefully compounded to react with one another
during mixing to develop a mass of cement possessing desirable physical properties.
COMPOSITION
Powder
The principal ingredient of the zinc phosphate cement is zinc oxide. Magnesium oxide,
silicon dioxide, bismuth trioxide, and other minor ingredients are used in some products
to alter the working characteristics and final properties of the mixed cement.
Zinc oxide (ZnO)

90.2

Magnesium oxide (MgO)

8.2

Silicon dioxide (SiO2)

1.4

Bismuth trioxide (Bi2O3)

0.1

Miscellaneous (BaO, Ba2So4, CaO)

0.1

The magnesium oxide, usually in quantities of about 10%, are added to the zinc oxide to
reduce the temperature of the calcinations process.
The silicon dioxide is inactive filler in the powder and during manufacture aids in the
calcinations process.
Although bismuth is believed to impart smoothness to the freshly mixed cement mass, in
large amounts it may also lengthen the setting time.
Tannin fluoride may be added to provide a source of fluoride ions in some products.
The ingredients of the powder are heated together at temperatures ranging from 1000 to
1300 C for 4 to 8 hours or longer, depending on the temperature. Calcinations results in a
fused or a sintered mass. The mass is then ground and pulverized to a fine powder, which
is sieved to recover selected particle sizes. The degree of calcination, fineness of the
particle size, and composition determine the reactivity of the powder with the liquid.

The powder particle size influences the setting rate. Generally the smaller the particle
size, the faster the set of the cement.
Liquid
Adding aluminum and sometimes zinc, or their compounds, to a solution of
orthophosphoric acid, produces zinc phosphate cement liquids. Although the original acid
solution contains about 85% phosphoric acid and is a syrupy fluid, the resulting cement
liquid usually contains about one third water
H3PO4 (free acid)

38.2

H3PO4 (combined with aluminum and zinc)


Aluminum (Al)

16.2

2.5

Zinc (Zn)

7.1

Water (H2O)

36.0

The partial neutralization of phosphoric acid by aluminum and zinc tempers the reactivity
of the liquid and is described as buffering. The reduced rate of the reaction helps establish
a smooth, non-granular, workable cement mass during the mixing procedure. Both partial
neutralizing or buffering and dilution adjust the zinc phosphate cement liquid so it reacts
with its powder to produce a cement mass with proper setting time and mechanical
qualities.
The composition of the liquid should be preserved to ensure a consistent reaction, as
water is critical to the reaction. Changes in composition and reaction rate may occur
either because of self-degradation or by water evaporation from the liquid. Selfdegradation of the liquid is best detected by clouding of the liquid over time.
SETTING REACTION
When the powder is mixed with the liquid the phosphoric acid attacks the surface of the
particles and releases zinc ions into the liquid. The aluminum, which already forms a
complex with the phosphoric acid, reacts with zinc and yields a zinc aluminophosphate
gel on the surface of the remaining portion of the particles. Thus the set cement is a cored
structure consisting primarily of unreacted zinc oxide particles embedded in a cohesive

amorphous matrix of zinc aluminophosphate. The set zinc phosphate cement is


amorphous and is extremely porous.
The surface of alkaline powder is dissolved by the acid liquid, resulting in an exothermic
reaction.
MANIPULATION
The manner in which the reaction between zinc phosphate cement powder and liquid is
permitted to occur determines to a large extent the working characteristics and properties
of the cement mass. Incorporate the proper amount of powder into the liquid slowly on a
cool slab (about 21 C) to attain the desired consistency of the cement.
POWDER LIQUID RATIO
Reducing the powder liquid ratio can increase working and setting times. This procedure
is however not acceptable means of extending setting time because it impairs the physical
properties and results in a lower initial pH of the cement. The powder liquid ratio is
1.4gm/0.5ml.
RATE OF POWDER INCORPORATION
Introduction of small quantity of powder into the liquid for the first few increments
increases working and setting times by reducing the amount of heat generated and
permits more powder to be incorporated into the mix.
CARE OF THE LIQUID
When zinc phosphate cement is exposed to a humid atmosphere it will absorb water,
whereas exposure to dry air tends to result in a loss of water. The addition of water causes
more rapid reaction with the powder, resulting in a shorter setting time. A loss of water
from the liquid results in a lengthened setting time. Therefore keep the bottle tightly
closed when not dispensing the material. Polyethylene squeeze bottles do not require
removal of a dropper and therefore eliminate the tendency for gain or loss of water from
the liquid.

MIXING SLAB
A properly cooled thick glass slab will dissipate the heat of the reaction. The mixing slab
temperature should be low enough to effectively cool the cement mass but must not be
below the dew point unless the frozen slab technique is used. A temperature of 18 to 24
C is indicated when room humidity permits. The moisture condensation on a slab cooled
below dew point contaminates the mix, diluting the liquid and shortening the setting time.
The ability of the mixing slab to be cooled and yet be free of moisture greatly influences
proper control of the reaction rate of zinc phosphate cement.
MIXING PROCEDURE
By incorporating small portions of the powder into the liquid, minimal heat is liberated
and easily dissipated. The heat of the reaction is most effectively dissipated when the
cement is mixed over a large area of the cooled slab. Use a relatively long narrow bladed
stainless steel spatula to spread the cement across this large area to control the
temperature of the mass and its setting time.
During neutralization of the liquid by the powder, the temperature of the mixing site is
inversely proportional to the time consumed in mixing. Thus a large volume of the
powder is carried to the liquid all at once rather than spatulated over a large area of the
slab for a sufficient time, the temperature at the site of the reaction becomes higher.
This temperature rise speeds the reaction and hinders control over the consistency.
During the middle of the mixing period, larger amounts of powder may be incorporated
to further saturate the liquid with the newly forming complex zinc phosphates. The
quantity of the unreacted acid is less at this time because of the prior neutralization
gained from initially adding small increments of powder. The amount of heat liberated
will likewise be less, and it can be dissipated adequately by the cooled slab.
Finally smaller increments of powder are again incorporated, so the desired ultimate
consistency of the cement is not exceeded.
Thus the mixing procedure begins and ends with small increments, first to achieve slow
neutralization of the liquid with the attendant control of the reaction and last to gain a
critical consistency.

Depending on the product 60 to 90 seconds of mixing appears adequate to accomplish a


proper zinc phosphate cementing mass.
CONTACT WITH MOISTURE
The area near the cement must be kept dry while the powder and liquid is mixed, during
insertion into the mouth and during hardening. If the cement is allowed to harden in the
presence of saliva some of the phosphoric acid is leaked out and the surface of the cement
will be dull and easily dissolved by oral fluids.
After the cement sets it should not be allowed to dry. Drying of the cement results in
shrinkage and crazing of the surface. A coating of varnish should minimize dehydration
as well as prevent premature contact with oral fluids.
WORKING TIME AND SETTING TIME
Working time is the time measured from the start of the mixing during which the
viscosity (consistency) of the mix is low enough to flow readily under pressure to form a
thin film. Adequate working time is expressed between 2.5 to 8 minutes at a body
temperature of 37 C. The first 60 to 90 seconds are consumed by mixing the powder and
liquid.
Setting time is the time elapsed from the start of the mixing until the point of the needle
no longer penetrates the cement as the needle is lowered onto the surface. Practically, it is
the time at which the zinc phosphate cement flash (excess) should be removed from the
margins of the restoration. The setting time can be measured with a 4.5 N (1 pound)
Gill more needle at a temperature of 37 C and relative humidity of 100%.
A reasonable setting time for zinc phosphate cement is between 5 to 9 minutes, as
specified in ADA specification no. 8.
FROZEN SLAB METHOD
The frozen slab method is a way to substantially increase the working time (4-11
minutes) of the mix on the slab and shorten the setting time (20 to 40% less) of the mix
after placement into the mouth.
In this method, a glass slab is cooled in a refrigerator at 6 C or in a freezer at 10C .

No attempt is made to prevent moisture from condensing on the slab when it is brought to
room temperature. A mix of cement is made on the cold slab by adding the powder until
the correct consistency is reached. The amount of powder incorporated with the frozen
slab method is 50% to 75% more than with the normal procedures. The compressive
strength and tensile strength prepared by the frozen slab method are not significantly
different from those prepared for normal mixes, however, because incorporation of
condensed moisture into the mix in the frozen slab method counteracts the higher powder
liquid ratio. This method has been advocated for cementation of bridges with multiple
pins.
MECHANICAL INTERLOCKING
Whenever an inlay is seated in a prepared cavity the surfaces of both the inlay and the
tooth have slight roughness and serrations into which the cement is forced.
thickness is a factor for retention.

Film

Thinner the cement better is the cementing action.

Zinc phosphate cements are irritating to the pulp. Although the pH of the cement
approaches neutral at 24 hours. Thinner mixes are more acidic and remain so for a longer
period of time than the standard mixes.
Berk, H. Stanely said that thin mix Zinc phosphate cements have more pulp response
than thick mix because Zinc phosphate cements is pushed into dentinal tubules and it
destroys the odontoblast right in place. The application of a cavity varnish to a cut tooth
structure can act as a barrier to the penetration of the acid.
A recent animal study involving cementation of crowns reported pulp response to none
when a cavity varnish was applied to the teeth prior to cementation of crowns. With
respect to the effect of retention, Fetton showed a coat of varnish to have no influence in
crown retention.
Molta JP said that cavity varnish has been shown to reduce the retention of cemented pins
and decrease tensile bond between two opposed dentinal surface when Zinc phosphate
cement is used for luting.

CHARACTERISTICS PROPERTIES
Physical and biologic properties
Two physical properties of the cement that are relevant to the retention of the fixed
prostheses are the mechanical properties and the solubilitys. The prosthesis can get
dislodged if the underlying cement is stressed beyond its strength. High solubility can
induce loss of the cement needed for the retention and may create plaque retention sites.
Zinc phosphate cement when properly manipulated exhibits a compressive strength of
104MPa and a diametral tensile strength of 5.5 MPa.
Zinc phosphate cement has a modulus of elasticity of approximately 13 GPa. Thus it is
quite stiff and should be resistant to elastic deformation even when it is employed for
cementation of restorations that are subjected to high masticatory stress.
A reduction in the powder liquid ratio of the mix produces a markedly weaker cement.
A loss or gain in the water content of the liquid reduces the compressive and tensile
strengths of the cement.
Retention
Whenever a casting is seated in the prepared tooth, the surfaces of both the casting and
the tooth structure have slight roughness and irregularities into which the plastic cement
is forced. Such extensions many times act as undercuts in providing retention of the inlay.
The thickness of the film between the casting and the tooth is also a factor in the
retention. The thinner the film, the better is the cementing action.
Solubility and disintegration
The premature contact of the incompletely set cement with water results in dissolution
and leaching of that surface. Prolonged contact even of well-hardened cement, with
moisture demonstrates that some erosion and extraction of soluble material does occur
from the cement.
Even the filling cement mixes show considerable loss of material in the mouth over a
period of time, indicating that zinc phosphate can be regarded only as a temporary filling
material. Wear abrasion and attack of food decomposition products accelerate the
disintegration of zinc phosphate cements. Greater resistance to disintegration is achieved

by increasing the powder liquid ratio. A thicker mix of cement exhibits less solubility
than a thinner mix.
Dimensional stability
Zinc phosphate cement exhibits shrinkage on hardening. The normal dimensional change
when properly mixed cement is brought into contact with water after it has set is that of
slight initial expansion, apparently from water absorption. This expansion is then
followed by slight shrinkage on the order of 0.04% to 0.06% in 7 days.
Consistency and film thickness
Two arbitrary consistencies of the cement are used based on their use.
Inlay seating or luting and cement base or filling. A third consistency which lies midway
between inlay seating and the cement base, is band seating consistency used for retention
of orthodontic bands.
The inlay seating consistency is used to retain alloy restorations. Although the
unhardened zinc phosphate cement is somewhat tenacious, the retaining action in its
hardened state is one of mechanical interlocking between the surface irregularities of the
tooth and the restoration.
The film thickness of the zinc phosphate cement greatly determines the adaptation of the
casting to the tooth and also determines the strength of the retention bond.
The maximum film thickness is 25 m. the heavier the consistency; the greater the film
thickness and the less complete the seating of the restoration.
The ultimate film thickness that a well-mixed, non-granular cement attains depends first
on the particle size of the powder and second on the concentration of the liquid.
The film thickness also varies with the amount of force and the manner in which this
force is applied to a casting during cementation.
An increased amount of powder incorporated into the liquid will increase the consistency
of the cement mass.
The operator must frequently test each mass as the end of mixing time approaches. The
final consistency will be fluid, yet will string up from the slab on the spatula about 2-3cm
as the spatula is lifted away from the mass.

A heavy putty like consistency of zinc phosphate cement is used as a thermal and
chemical insulating barrier over thin dentin and a high strength base.
Viscosity
The consistency of cements can be quantified by measuring viscosity. A small but
significant increase in viscosity is seen at higher temperatures. A rapid increase in
viscosity demonstrates that restorations should be cemented promptly after completion of
the mixing to take advantage of the lower viscosity of the cement. Delays in cementation
can result in considerably thick film and insufficient seating of the restoration.
Acidity
During the formation of zinc phosphate cement, the union of zinc oxide powder with
phosphoric acid liquid is accompanied by a change in pH. In the early stages the pH
increases rapidly, with a standard mix reaching the pH of 4.2 within 3 minutes after
mixing has started. At the end of one hour this value increases to about 6 and is nearly
neutral at 48 hours.
Investigations have shown that the initial acidity of zinc phosphate cement at the time of
placement into the tooth may excite pulpal response, especially where only a thin layer of
dentin exists, between cement and pulp.
Thermal and electrical conductivity
One of the primary uses of zinc phosphate cement is an insulating base under metallic
restorations.

APPLICATIONS
Zinc phosphate cement is used most commonly for luting permanent metal restorations
and as abase.
Other applications include cementation of orthodontic bands and the use of cement as a
provisional restoration.
ADVANTAGES
1. Adequate strength to maintain the restoration
2. Relatively good manufacturer properties
3. Mixed easily and that they set sharply to a relatively strong mass from a fluid
consistency.
DISADVANTAGES
1. Irritating effect on the pulp
2. Lack of anticariogenic properties
3. Lack of adhesion to the tooth
4. Vulnerability to acid attack
5. Brittleness
6. Solubility in acid fluids.

REACTION OF PULP TO CEMENT


The phosphoric acid in Zinc phosphate cement can be the cause of the pulpal reaction.
The closer it approaches the pulp, the greater is the intensity of the response. Also the
ratio of powder to liquid is important consideration. A thick mix of Zinc phosphate
cement used as a base will generate a moderate localized response, whereas a thin mix
used to cement on a crown that is placed under great pressure by patients biting on a
tongue blade can cause a very severe reaction.

ZINC SILICOPHOSPHATE CEMENT


They are also called as Zinc silicate, Silicate zinc cement.
Zinc silicophosphate cement is a hybrid resulting from the combination of zinc phosphate
cement and silicate powders.
TYPES OF ZINC SILICOPHOSPHATE CEMENTS
According to ADA no 28 (1969) there are three types
Type I as a cementing media
Type II temporary posterior filling material
Type III dual purpose cementing media and temporary posterior filling material.
PROPERTIES
Zinc silicophosphate cements (ZSP) consist of mixture of silicate glass, a small
percentage of zinc oxide powder and phosphoric acid.
They are used as luting agents for restorations and orthodontic bands, intermediate
restorations and as die material.
Its strength is somewhat superior to that of zinc phosphate cement, and the major
difference is that Zinc silicophosphate cement appears somewhat translucent and releases
fluoride by virtue of silicate glass.
Clinical observation has shown that silicophosphate is less soluble in the mouth than
zinc phosphate cement. The fluoride content should give some antocariogenic action.
Therefore it is recommended for cementation of restoration in patients with high caries
rate.
The flow property of the mix is not as good as zinc phosphate cement, leading to higher
film thickness. The cement does not bound to tooth structure; hence retention is by
mechanical interlocking.
Esthetically it is superior to the more opaque zinc phosphate cement for cementation of
ceramic restorations.
The use of Zinc silicophosphate cement is declining, as practitioners have choice of other
more esthetically pleasing materials such as resin and glass ionomer cements.

ADVANTAGES
1. Zinc silicophosphate cements have a better strength and toughness than zinc
phosphate cements
2. Shows considerable fluoride release hence anticariogenic
3. Translucent
4. Under clinical conditions lower solubility and better bonding
5. Best suited to cement of ortho bars and restoration on non-vital teeth.
DISADVANTAGES
1. Less satisfactory mixing
2. Higher film thickness
3. Greater pulpal irritation
TRADE NAMES
Flourathin and Lucent ( type I)

ZINC POLYCARBOXYLATE CEMENT


In the quest for an adhesive cement that can bond strongly to the tooth structure, Zinc
polycarboxylate cement was the first cement system that developed an adhesive bond to
tooth structure in 1960.
COMPOSITION
Zinc polycarboxylate cement or zinc polyacrylate cements are supplied as a powder and
liquid or as a powder that is mixed with water.
The cement powder is essentially zinc oxide and magnesium oxide that have been
sintered and ground to reduce the reactivity of zinc oxide. Stannic acid may be
substituted for magnesium oxide. Other oxides such as bismuth and aluminum can be
added. The powder may also contain small quantities of stannous fluoride, which modify
setting time and enhance manipulative properties. It is an important additive because it
increases strength. However, the fluoride released from this cement is only a fraction. The
cement powder that is mixed with water contains 15 % to 18% polyacrylic acid coated on
the oxide particles.
The liquid is a water solution of polyacrylic acid. Most commercial liquids are supplied
as 32% to 42% solution of polyacrylic acid having molecular weight of 25,000 to 50,000.
The manufactures control the viscosity of the cement liquid by varying the molecular
weight of the polymer or by adjusting the pH by adding sodium hydroxide. Itaconic and
tartaric may be present to stabilize the liquid, which can gel on extended storage.
SETTING REACTION
The setting reaction of this cement involves particle surface dissolution by acid that
releases zinc, magnesium, and tin ions, which bind to the polymer chain via the carboxyl
groups. These ions react with carboxyl groups of adjacent polyacid chains so that a crosslinked salt is formed as the cement sets. The hardened cement consists of an amorphous
gel matrix in which unreacted particles are dispersed. The microstructure resembles that
of zinc phosphate cement in appearance.
Water settable versions of this cement are available. The polyacid is a freeze-dried
powder that is then mixed with the cement powder. The liquid is water or a weak solution

of NaH2PO4. However the setting reaction is the same whether the polyacid is freeze
dried and subsequently mixed with water or if the conventional aqueous solution of
polyacid is used as the liquid.
MANIPULATION
Mixing
The cement liquids are quite viscous. The viscosity is a function of the molecular weight
and the concentration of the polyacrylic acid thereby varies. Generally the powder liquid
ratio is 1.5 parts of powder to 1 part of liquid by weight. The consistency of the mixes is
creamy compared with that of zinc phosphate cements. The mixes cement is
pseudoplastic that is the viscosity decreases as the shear rate increases, or in other terms,
the flow increases as spatulation increases or as force is placed on the material. The
correct consistency is found in a mix that is viscous but that will flow back under its own
weight when drawn up with a spatula.
The cement liquid should be mixed on a surface that does not absorb liquid. A glass slab
affords the advantage over paper pads supplied by the manufacturers because once it is
cooled it maintains the temperature longer. The cool slab and powder provides for longer
working time, but under no circumstances should the liquid be cooled in a refrigerator.
Mix polyacrylate cements within 30 to 60 seconds, with half to all of the powder
incorporated at once to provide the maximum length of working time 2.5 to 6 minutes.
Working time can be extended to 10-15 minutes by using a cool slab chilled to 4C.
The liquid should not be dispensed before the time when the mix is to be made. It loses
water to the atmosphere rapidly and this results in marked increase in viscosity.
Use the mixed cement only as long as it appears glossy on the surface. Once the surface
becomes dull, the cement develops stringiness and the film thickness becomes too great
to seat a casting completely.
If good bonding to tooth structure is to be achieved, the cement must be placed on the
tooth surface before it loses its glossy appearance. The glossy appearance indicates a
sufficient number of free carboxylic acid groups on the surface of the mixture that are
vital for bonding to tooth structure.

Surface penetration and retention


Despite the adhesion of the cement to tooth structure, polycarboxylate cements are not
superior to zinc phosphate cement in the retention of cast noble metal restorations.
A comparable force is required to remove gold inlays cemented either with zinc
phosphate cement or with polycarboxylate cement. Examination of fractured surfaces
shows that failure usually occurs at the cement tooth interface with zinc phosphate
cement.
In the case of polycarboxylate cements, the failure occurs usually at the cement metal
interface.
The cement does not bond to the metal in the chemically contaminated condition. Thus it
is essential that this contaminated surface on the casting be removed to improve
wettability and the mechanical bond at the cement metal interface. The surface can be
carefully abraded with a small stone, or it can be sandblasted with high-pressure air and
alumina abrasives.
Because this type of cement affords an opportunity to obtain adhesion to tooth structure, a
clean cavity surface is necessary to ensure intimate contact and interaction between
cement and the tooth. A recommended procedure is to apply a 10% polyacrylic acid
solution for 10 to 15 seconds followed by rinsing with water.
Removal of excess cement
During setting the polycarboxylate cement passes through a rubbery stage that makes the
removal of the excess cement quite difficult. The excess cement that has extruded beyond
the margins of the casting should not be removed while the cement is in this stage,
because some of the cement may be pulled out from beneath the margins leaving a void.
The excess should be removed when the cement becomes hard. The outer surface of the
prosthesis should be coated with a separating medium like petroleum jelly, to prevent
excess from adhering.
Another approach is to start removing excess cement as soon as seating is completed.

PROPERTIES
Viscosity
The initial viscosity of zinc polycarboxylate cement is higher than zinc phosphate
cements and a delay of 2 minutes in cementation reverses the situation.
Film thickness
When polycarboxylate cements are mixed they appear to be much viscous than zinc
phosphate cement.

Since zinc polycarboxylate cement is pseudoplastic cement it

undergoes thinning at an increase shear rate. Clinically, this means that the action of
spatulation and seating with a vibratory action will reduce the viscosity and yield a film
thickness of 25- m or less.
Working time and setting time
The working time for polycarboxylate cement is much shorter than phosphate cement that
is 2.5 minutes. Lowering the temperature of the reaction can increase the working time
that may be necessary for fixed bridges. Unfortunately, the temperature of the cool slab
can cause the polyacrylic acid to thicken. The increased viscosity makes the mixing
procedure more difficult. It has been suggested that only the powder should be
refrigerated before mixing.
The setting time ranges from 6 to 9 minutes.
Mechanical properties
The compressive strength of polycarboxylate cement is 55 Mpa.
The diametrical tensile strength is slightly higher than that of zinc phosphate cement.
Its modulus of elasticity is less than half.
Brown stated that an increse in the compressive and tensile strength of polycarboxylate
cement can be obtained with the addtion of stainless steel powder or fibers .
Zinc polycarboxylate cement is not as brittle as zinc phosphate cement.
Thus it is more difficult to remove the excess after the cement has set.

Solubility
The solubility of the cement in water is low, but when it is exposed to organic acids with
a pH of 4.5 or less, the solubility markedly increases.
Also a reduction in the powder liquid ratio results in significantly higher solubility and
disintegration rate in the oral cavity.
Bond strength
An interesting feature of polyacrylate cement is its bonding to enamel and dentin, which
is attributed to the ability of the carboxylate groups in the polymer molecule to chelate to
calcium. The bond strength to enamel has been reported to be from 3.4 to 13 MPa and to
that of dentin is 2.1 MPa. Optimum bonding requires clean tooth surface. Sand blasting
or electrolytic etching of the gold alloy surface is necessary to achieve optimum bonding.
Dimensional stability
The zinc polyacrylate cement shows a linear contraction when setting at 37 C. the amount
of contraction varies from 1 % for a wet specimen at 1 day to 6 % for a dry specimen at
14 days. These contractions are more pronounced than those observed for zinc phosphate
cements and start earlier.
Acidity
Zinc polyacrylate cements are slightly more acidic than zinc phosphate cements when
first mixed but the acid is only weakly dissociated, and penetration of the highly
molecular weight polymer molecules toward pulpal tissue is minimal.
Mortiner noted that film thickness is thicker than zinc phosphate cement.
According to Wilson and Paddon the cement remains much less brittle and is tougher
than silicate, zinc phosphate and glass ionomer cement.
Abelson said that the retention of full crown was similar to zinc phosphate.

APPLICATIONS
Zinc polyacrylate cements are used primarily for luting permanent alloy restorations and
as bases. Theses cements have also been used in orthodontics for cementation of bands.
ADVANTAGES
1. Biocompatibility with the pulp is excellent. Postoperative sensitivity is negligible
when used as a luting agent
2. Adhesion to tooth and alloy
3. Easy manipulation.
DISADVANTAGES
1. Need for accurate proportioning required for optimal properties
2. Greater viscoelasticity
3. Shorter working time
4. Low compressive strength
5. More critical manipulation.
TRADE NAMES
Dertelon (Premier dental products)
PCA (S.S. White)
Cermaco (Johnson & Johnson)

GLASS IONOMER CEMENT


Glass ionomer is the generic name of a group of materials that use silicate glass powder
and an aqueous solution of polyacrylic acid. The material acquires its name from its
formulation of a glass powder and an ionomeric acid that contains carboxyl groups. It is
also referred to as polyalkeonate cement.
Originally, the cement was designed for the esthetic restoration of anterior teeth and it
was recommended for use in restoring teeth with class III and V cavity preparations. Also
because the cement produces a truly adhesive bond to tooth structure.
APPLICATIONS
The use of GIC has broadened to encompass formulations as luting agents, liners,
restorative materials, core build-ups and pit and fissure sealants.
TYPES OF GLASS IONOMER CEMENT
There are three types based on their formulations and their potential uses
Type I

Luting applications

Powder liquid ratio is generally 1.5 : 1

Grain size 15 m or less

High early resistance to water contamination

Radiopaque for easy detection of excess

Limited extension of working time thru chilling glass slab.

Type II

Restorative material

Powder liquid ratio 3:1

Must protect for 24 hours for best results

Reduced fluoride content to improve translucency

Type III

Liner and base.

Powder liquid ratio varies according to use

Lining requires 1.5:1 for easy

Base requires 3:1 or greater for strength

Light activated varieties available

Type IV
Metal modified glass ionomer cement

Miracle mix

Cermet cement

Light curable versions of GIC are also available. (HEMA added to liquid)
Hybrid glass ionomer \ resin modified

COMPOSITION
The glass ionomer powder is an acid soluble calcium fluroaluminosilicate glass.
The raw materials are fused to a uniform glass by heating them to a temperature of
1100 C to 1500 C. Lanthanum, strontium, barium or zinc oxide additions provide
radiopacity. The glass is ground into a powder having particles in the range 20 to 50 m.
SiO2

29.0

Al2O3

16.6

AlF3

5.3

CaF2

34.3

AlPO4

9.8

Fluoride is an essential constituent of glass ionomer cement. It lowers the temperature of


fusion, increases the strength and improves the working characteristics of the cement
paste.
The liquid for GIC was aqueous solutions of polyacrylic acid in a concentration of about
50 %. The liquid was quite viscous and tended to gel over time. The acid is form of a
copolymer with itaconic, maleic, or tricaboxylic acid. Theses acids tend to increase the
reactivity of the liquid, decreases the viscosity, and reduce the tendency for gelation.
The copolymeric acids used in modern glass ionomer liquids are more irregularly
arranged than in the homopolymer of acrylic acid. This configuration reduces hydrogen
bonding between acid molecules and thus reduces the degree of gelling. Tartaric acid
present in the liquid improves the handling characteristics and increases the working time
however it shortens the setting time.
One of the glass ionomer formulations consist of freeze dried acid powder and glass
powder in one bottle and water or water with tartaric acid in another bottle as the liquid
component. When the powders are mixed with water, the acid dissolves to reconstitute
the liquid acid. The chemical reaction then proceeds in the same manner as that
demonstrated by the powder liquid system. This is usually done to extend the working
time. These cements have a longer working time with a shorter setting time. They are
referred to as water settable GICs or as anhydrous GICs.
Simmons and Murray et al say that compressive strength has been found to be
significantly increased with the addition of silver alloy powder.
McLean showed that a simple matrix of metal powder and alumino silicate glass ionomer
powder failed to form a sufficient bond at metal/ polyacrylate interface. The glass
ionomer cement is capable of establishing a bond with the dentin substrate before
development start, but the composite start only after stress is started

CHEMISTRY OF SETTING
Glass ionomer cement is an acid base reaction cement as defined by Wilson and Wygant.
When the powder and liquid are mixed to form a paste, the surface of the glass particles
is attacked by the acid. Calcium, aluminium, sodium and fluorine ions are leached into

the aqueous medium. The polyacrylic acid chains are cross-linked by the calcium ions
and form a solid mass. Within the next 24 hours a new phase forms in which aluminum
ions become bound within the cement mix. This leads to more rigid cement. Sodium and
fluorine ions do not participate in the cross linking of the cement. Some of the sodium
ions may replace the hydrogen ions of carboxylic group, where as the rest combines with
fluorine ions, forming sodium fluoride uniformly dispersed within the set cement. During
the maturing process, the cross-linked phase is also hydrated by the same water used as
the medium. The unreacted portion of glass particles are sheathed by silica gel that
develops during removal of the cations from the surface of the particles. Thus, the set
cement consists of an agglomeration of unreacted powder particles surrounded by a silica
gel in an amorphous matrix of hydrated calcium and aluminum polysalts.
ROLE OF WATER IN THE SETTING PROCESS
Water is a most important constituent of the cement liquid. It serves as the reaction
medium initially, and then it slowly hydrates the cross linked matrix, thereby increasing
the material strength. During the initial reaction period, this water can readily be removed
by desiccation and is called loosely bound water. As the setting continues, the same water
hydrates the matrix and cannot be removed by desiccation and is then called tightly
bound water. This hydration is critical in yielding a stable gel structure and building the
strength of the cement.
If freshly mixed cements are kept from the ambient air, the loosely held water will slowly
become tightly bound water over time. This phenomenon results in cement that is
stronger and less susceptible to moisture.
If the same mixes are exposed to ambient air without any covering, the surfaces will
craze and crack as a result of desiccation. Any contamination by water that occurs at this
stage can cause dissolution of the matrix forming cations and anions to the surrounding
areas. This process results in weak and more soluble cement. Although the dissolution
susceptibility tends to decrease over time, the minimum time at which the danger of
cracking from the exposure to air no longer exists has not been established. The ionomer
cement must be protected against water changes in the structure during placement and for
a few weeks after placement if possible.

ROLE OF FLUORIDE
Glass ionomer cements are bioactive. They form permanent adhesive bonds to dentin and
enamel, hence preventing the development of secondary caries.
They also release fluoride over a prolonged period and so can arrest the progress of
caries.
Of all dental cements they are the most resistant to erosion in the acidic stagnation
regions of the mouth.
MANIPULATIONS
To achieve a long lasting restoration several conditions need to be satisfied like
appropriate cavity surface preparation to achieve the bonding, proper mixing to obtain a
workable mixture.
SURFACE PREPARATION
Clean surfaces are essential to promote adhesion. A pumice wash can be used to remove
the smear layer that is produced during cavity preparation. On the other hand organic
acids such as polyacrylic acids of various concentrations can remove the smear layer but
still leave the collagenous tubule plug in place. These plugs inhibit the penetration of the
cement constituents and affect the hydrodynamic fluid pressure within dentin.
One workable method is to apply a 10 % of polyacrylic acid solution to the surface for 10
to 15 seconds, followed by a 30 second water rinse.t5he smear layer will be removed but
the tubules remain plugged. This procedure of removing the smear layer is called
conditioning.
The purpose of pumice debridement is to remove the fluoride rich layer surface that may
compromise the surface conditioning process.
After conditioning and rinsing of the preparation, the surface should be dried but it
should not be unduly desiccated. It must remain clean because any further contamination
by saliva or blood impairs bonding of the cement.

PREPARATION OF THE MATERIAL


Glass ionomer cements mixed with carboxylic acid liquids have a powder liquid ratio of
1.3: 1 or 1.35: 1, but it is the range of 1.25 to 1.5 g of powder per 1 ml of liquid.
The powder and liquid are dispensed on a paper or a glass slab. A cool dry glass slab may
be used to slow down the reaction and extend the working time .the slab should not be
used if the temperature is below dew point, that is, at temperatures that enhance moisture
condensation on the glass slab that can alter the acid water balance needed for a proper
reaction. By waiting for a few minutes, the temperature of the slab will rise sufficiently
until water vapor no longer condenses on its surface.
The powder and liquid should not be dispensed onto the slab until just before the mixing
procedure is to be started. Prolonged exposure to the office atmosphere alters the precise
acid water ratio of the liquid. The powder is divided into two equal portions. The first
portion is incorporated into the liquid with a stiff spatula before the second portion is
added. The mixing time is 30 to 60 seconds. At this time the mix should have a glossy
surface. The shiny surface indicates the presence of polyacid that has not participated in
the setting reaction. The residual acid ensures adhesive bonding to the tooth. If the
mixing process is prolonged, a dull surface develops, and adhesion will not be achieved.
Encapsulated products are typically mixed for 10 seconds in a mechanical mixer and
dispensed directly onto the tooth and restoration.
The cement must be used immediately because the working time after mixing is about 2
minutes at room temperature. An extension of the working time to 9 minutes can be
achieved by mixing on a cool slab, (3 C), but because a reduction in compressive
strength and modulus of elasticity is observed, this technique is not recommended. Do
not use the cement once a skin forms on the surface or when the viscosity increases.
Glass ionomer cements are very sensitive to contact with water during setting. The filed
must be isolated completely. Once the cement has achieved its initial set (7 minutes), coat
the cement margins with the coating agents supplied with the cement.
It is important to prevent excess cement from spreading to the tooth structure or to the
prosthesis. This cement is particularly susceptible to attack by water during setting.
Therefore, the accessible margins of the restoration should be coated to protect the
cement from premature exposure to moisture.

PROPERTIES
Film thickness
The glass ionomer cement is capable of forming films of 25m or less.
Working time and setting time
The working time ranges from about 3 to 5 minutes the water settable cements tend to
have somewhat longer working time.
The setting time is usually between 5 to 9 minutes. The water added cements have a more
rapid initial set than those that use the polyacid liquid.
Both working time and setting time can be determined by indentation tests.
The oscillating rheometer of Wilson gives more information and is a better measure of
working time. Its dynamic nature is closer to the clinical than is static indentation test.
Strength
The 24-hour compressive strength of Glass ionomer cements ranges from 90 to 230 MPa
and is greater than that of zinc phosphate cement.
Tensile strength is similar to those of zinc phosphate cement.
Glass ionomer cements show brittle failure in diametral compression tests.
The elastic modulus of glass ionomer cements is less than that of zinc phosphate but
more than that of zinc polycarboxylate cement. The rigidity of glass ionomer cements is
improved by the glass particles and the iononic nature of the bonding between polymer
chains.
Bond strength
Glass ionomer cements bond to dentin with values of tensile bond strength reported
between 1 and 3 MPa. The bond strength of glass ionomer cements to dentin is somewhat
lower than that of zinc polyacrylate cement, perhaps because of the sensitivity of glass
ionomer cements to moisture during setting. The bond strength has been improved by
treating the dentin with an acidic conditioner followed by an application of a dilute
aqueous solution of ferric chloride.

Glass ionomer cements bond well to enamel, stainless steel, and tin oxide plated platinum
and gold alloy.
Solubility
The solubility in water for the first 24 hours is high. It is important that the cement should
be protected from any moisture contamination during this period. After the cement has
been allowed to mature fully, it becomes one of the most resistant of the nonresin
cements to solubility and disintegration in the oral cavity.
Biologic properties
The glass ionomer cements bond adhesively to tooth structure and they inhibit infiltration
of oral fluids at the cement tooth interface. This particular property plus the less irritating
nature of the acid should reduce the frequency of postoperative sensitivity.
There are several factors contributing to the irritant nature. One is the pH and the length
of time that this acidity persists.
Another factor may be the viscosity. The pH relate to the thinner mixes used for
cementation and do not apply to the higher powder liquid ratio.
Glass ionomer luting cements may cause prolonged hypersensitivity, varying form mild
to severe, micro leakage has been suggested as an explanation, but a recent study showed
no increase in bacterial counts 56 days after cementation of crowns with a glass ionomer
cements. These cements may be bacteriostatic or bactericidal because of fluoride release.
Graver says that post-cemented micro leakage is the cause of tooth sensitivity.
Smith D.C. states the cause of post cemented sensitivity as bacterial invasion, hydraulic
pressure, acidity in the early setting stage and wash out of thin mix.
Taywn stated that the higher the powder liquid ratio the greater is the thermal diffusivity.
ADHESION
Glass ionomer has the property of permanent adhesion to untreated enamel and
dentin under moist conditions of the mouth. It reacts with the smear layer on cut dentin
(more for a filling material than for a luting agent). Glass ionomer also bonds to other
reactive polar substrates such as the base metals.

Bonding is of a chemical rather than a micro mechanical nature. Therefore, no


acid etching or surface roughening procedures is deprecated. About 80% of maximum
bond strength is developed in 15 minutes but strength slowly increases for several days
after that.
MECHANISM OF ADHESION TO ENAMEL AND DENTINE
Chemically, tooth material consists of apatite, which makes up 98% of enamel
and 70% of dentin by weight and collagen, which is found in dentin alone. The bond of
glass ionomer cements is better to enamel than to dentine, because bonding to apatite is
the principal mode of adhesion.
Beech proposed that the interaction between apatite and polyacrylic acid produced
polyacrylate ions, which then formed strong ionic bonds with the surface calcium ions of
apatite in enamel and dentine.
Wilson suggested that initially, when the cement paste is applied to tooth material
and is fluid, wetting and initial adhesion is by hydrogen bonding provided by free
carboxyl groups present in the fresh paste. As the cement ages, the hydrogen bonds are
progressively replaced by ionic bonds. The cations coming either from the cement or the
hydroxyapatite. Polymeric polar chains of polyacid are essential for the achievement of
adhesion. Their role is thought to be one of bridging the interface between the cement
and the substrate.
Wilson et al postulated that during absorption polyacrylate entered the molecular surface
of hydroxyapatite, displacing and replacing the surface phosphate. Also calcium ions are
displaced from hydoxypatite along with phosphate during this ionic exchange. Therefore,
an intermediate layer of calcium and aluminium phosphates and polyacrylates would
form at the interface between the cement and apatite.
Chain length is also an important factor in adhesion. The polymer chains capable
of bridging gaps between the cement body and substrate.
Bonding to enamel, which is mostly apatite is due to ionic and polar forces and
bonding to dentine is only to the apatite constituent of the dentine. Therefore, the
adhesion of glass ionomer to dentine is weaker.

Collagen contains both amino and carboxylic acid groups, so adhesion could be
due to hydrogen bonding or cationic bridges.
However, recent absorption studies show that polyacrylic acid and polyacrylate are not
absorbed on collagen.
Cements based on polyacrylic acid appear to bond more strongly than those based
on copolymers of acrylic acid with itaconic or maleic acids.

Evidence is only

accumulating that bond strength to tooth substances depends on the nature of the polyacid
used.
If it were proved, then the molecular configuration of the polyacid would become
an important factor in controlling adhesion.
IMPROVING ADHESION
When the cement tooth bonds fractures, it is by cohesive failure within the cement
rather than adhesive failure at the interface. Therefore, the strength of the bond is limited
by the cohesive strength of the cement used. The smear layer is considered to be
beneficial.

However, salivary contamination of a freshly prepared dentine surface

reduces bond strength, but whether this was because of its water contact or contamination
of the dentin surface is uncertain.
SURFACE CONDITIONING
A number of research workers have sought to improve adhesion of glass ionomer
cements. One way that is common to nearly all adhesive technologies is by pretreatment
of the surface.
Mclean and Wilson first used the term surface conditioning for this treatment in order to
differentiate it from acid etching. Surface conditioning is needed in order to eliminate the
wide variation found in the structures of the tooth surfaces following cutting. Rough
tooth surfaces are contraindicated. In general, the smoother the surface, the stronger is
the bond. Good interfacial contact is important for adhesion. Smoothening is necessary
to prevent air entrapment and to minimize sites where stress concentration could occur.

FLUORIDE RELEASE
Both enamel and cementum can absorb fluoride. Fluoride is incorporated within
the mineral structure as fluoridated hydroxy apatite. Plentiful fluoride is released in the
early life of the restoration and it gradually decreases over a period.
Fluoride is released for at least 18 months.

Thickly mixed cements released more

fluoride because they contain proportionately more glasses and therefore more fluoride.
Not all the fluoride is available for release. It is released as sodium fluoride and is
restricted by the sodium and the calcium content of the glass and not by the total fluoride
content of the glass. Sodium fluoride is released preferentially from the matrix rather
than the filler. The rate of release is proportional to the inverse of the square root of time.
Aluminum ions are also released, temporarily and ceases once the cement has fully
hardened. Aluminum ions absorbed by enamel confer acid resistance upon the tooth.
ACTION OF FLUORIDE IN PREVENTION OF CARIES
The anticaries effect can be due to the uptake of fluoride ions by enamel apatite at
hydroxyl sites, and high fluoride level at enamel surfaces increases resistance to plaque
acids. Surface energy of apatite is decreased, therefore, the dental plaque does not adhere
to tooth enamel surfaces.
REACTION OF CEMENT ON PULP
Several reasons have been postulated as to why Glass ionomer cement does not
have the same damaging effect on the pulp than Zinc phosphate cement.
First being the polycarboxylic acid used is much weaker than phosphoric acid.
Second, the acid is a polymer, means that it will have a much higher molecular weight
and this will limit diffusion along the dentinal tubules towards the pulp.
Thirdly, there is a strong electrostatic attraction between hydrogen ions and negatively
charged polymer chain and dissociation will less readily take place than with simple
anions.
APPLICATIONS
Glass ionomer cements are primarily used for permanent cement, as a base, and as a class
V filling material.

The cement has been evaluated as a pit and fissure sealant and an endodontic sealer.
Glass ionomer cements are being used clinically for cementation of orthodontic bands
because of their ability to minimize decalcification of enamel by means of fluoride
release.

HYBRID IONOMER CEMENTS


Self cured and light cured ionomers (or resin modified glass ionomers) are available for
cementation.
COMPOSITION
One self-cured hybrid ionomer cement powder contains a radiopaque,
fluroaluminosilicate glass and a micro encapsulated potassium persulfate and ascorbic
acid catalyst system.
The liquid is an aqueous solution of polycarboxylic acid modified with pendant
methacrylate groups. It also contains 2 hydroxyethylmethacrylate (HEMA) and tartaric
acid.
Another self-cured cement contains a mixture of fluroaluminosilicate and borosilicate
glasses in the powder. Its liquid is a complex monomer containing carboxylic acid groups
that can undergo an acid base reaction with glass and vinyl groups that can polymerize
when chemically activated.
A light cured hybrid ionomer cement contains fluroaluminosilicate glass powder and a
copolymer of acrylic and maleic acids, HEMA, water, camphoroquinone and an activator
in the liquid.
SETTING REACTION
Setting of hybrid ionomer cements usually results from an acid base glass ionomer
reaction and self-cured or light cured polymerization of the pendant methacrylate groups.
Some cements are only light cured.
MANIPULATION
The powder is fluffed before dispensing. The liquid is dispensed by keeping the vial
vertical to the mixing pad. The powder liquid ration is 1.6 g of powder to 1.0 g of liquid,
and the powder is incorporated into the liquid within 30 seconds to give a mousse like
consistency. The working time is 2.5 minutes. The cement is applied to a clean dry tooth
that is not desiccated. Some products recommend the use of a conditioner for enhanced
bonding to dentin. No coating agent is needed.

HEMA is known as a contact allergen therefore the use protective gloves and a no touch
technique are recommended.
PROPERTIES
The compressive and tensile strengths of hybrid ionomer cement are similar to glass
ionomer cements.
The fracture toughness is higher than that of other water based cements but lower than
composite cements.
The bond strength to moist dentin ranges from 10 to 14 MPa and is much higher than that
of most water based cements.
Hybrid ionomer cement have very low solubility when tested by lactic acid erosion.
Water sorption is higher than resin cements.
Fluoride release is similar to glass ionomer cements. The early pH is about 3.5 and
gradually rises.
APPLICATIONS
Self cured hybrid ionomer cement are indicated for permanent cementation of porcelain
fuse to metal crowns, bridges, metal inlays, on lays, and crowns, post cementation and
luting of orthodontic appliances.
Additional uses include adhesive liners for amalgam, bases, provisional restorations and
cementation of specific ceramic restorations.

ZINC OXIDE EUGENOL CEMENT


This material has been used to a wide range applications in dentistry including its use as
an impression material for edentulous arches, a surgical dressing, a bite registration paste,
a temporary filling material, root canal filling, a cementing medium, and as a temporary
relining material for dentures.
ZOE cement is one of the least irritating of all the dental materials and provides an
excellent seal against leakage.
TYPES
According to ADA specification 30
Type I ZOE cement temporary cementation
Type II ZOE cements permanent cementation of restorations or appliances fabricated
outside of the mouth
Type III ZOE cements temporary restoration and thermal insulating bases
Type IV ZOE cements cavity liner
COMPOSITION
These materials are dispensed in two separate pastes. One tube contains zinc oxide and
fixed vegetable or mineral oil acts as a plasticizer and aids in off setting the action of the
eugenol as an irritant. The zinc oxide should be finely divided and it should contain only
a slight amount of water. Oil of cloves, which contains 70 % to 85% eugenol, is
sometimes used in preference to eugenol because it reduces the burning sensation
experienced by patients when it contacts the soft tissues.
The addition of rosin to the paste in the second tube apparently facilitates the speed of the
reaction, and it yields a smoother, more homogenous product. Canada balsam and Peru
balsam are often used to increase flow and improve mixing properties. If the mixed paste
is too thin or it lacks body before it sets, a filler (such as wax) or an inert powder (such as
kaolin, talc, diatomaceous earth) may be added to one or both of the original pastes.
There are many soluble salts that may act as accelerators. Chemicals commonly used are
zinc acetate, calcium chloride, primary alcohols and glacial acetic acid. The accelerator
can be incorporated in either one or both pastes.

Tube no 1 (base)
Zinc oxide

87

Fixed vegetable or mineral oil

13

Tube no 2 (catalyst)
Oil of cloves or eugenol

12

Gum or polymerized resin

50

Filler (silica type)


Lanolin
Resinous balsam
Accelerator solution and color

20
3
10
5

CHEMISTRY
The setting mechanism for ZOE material consists of zinc oxide hydrolysis and a
subsequent reaction between zinc hydroxide and eugenol to form a chelate.
Water is needed to initiate the reaction and it is also a by-product of the reaction. This
type of reaction is called autocatalytic. This is the reaction why the reaction proceeds
more rapidly in a humid environment. The setting reaction is accelerated by the presence
of zinc acetate dihydrate, which is more soluble than zinc hydroxide and which can
supply zinc ions more rapidly. Acetic acid is a more catalyst for setting reaction than is
water, because it increases the formation rate of zinc hydroxide. High atmospheric
temperature also accelerates the setting reaction.
The free eugenol cement of the set cement is probably extremely low. It appears to be
much higher than it actually is, because the chelate hydrolyzes readily, forming free
eugenol and zinc ions.

MANIPULATION
The mixing of the two pastes is generally accomplished on an oil impervious paper,
although a glass-mixing slab can be used. The proper proportion of the two pastes is
generally achieved by squeezing two strips of the paste of the same length, one from each
tube, onto the mixing slab. A flexible stainless steel spatula is satisfactory for the mixing.
The two strips are combined with the first sweep of the spatula, and the mixing is
continued for approximately 1 minute until a uniform color is observed.
Cements intended for final cementation of restorations carry manufacturers directions and
measuring devices that are important to use, because of the deceptive flow qualities of
these cements, adding powder until the operator feels the mix is of suitable consistency
for cementing a restoration will lead to a cement deficient in powder and a lowered
strength in the set cement.
PROPERTIES
Setting time
The initial setting time may vary between 3 to 6 minutes.
The final setting time is the time at which the material is hard enough to resist penetration
under a load. It can occur within 10 minutes for type I pastes and 15 minutes for type II.
The actual setting time is shorter when the setting occurs in the mouth.
Film thickness
The film thickness should not be more than 25 m for cements used for permanent
cementation and not more than 40 m for cements used for temporary cementation.
Compressive strength
A maximum value of 35MPa is required for cements intended for temporary cementation.
A minimum of 35 MPa is required for cements intended for permanent cementation.
The strength of the cement for temporary cementation is selected in relation to the
retentive characteristics of the restoration and the expected problems of removing the
restoration when the time arrives.

Disintegration
A maximum value of 2.5% is acceptable for provisional cementing materials but a value
of 1.5 % is required for the other cements.
PROVISIONAL CEMENTATION
On many occasions, cementing a restoration provisionally is advised not that the
patient and dentist can assess its appearance and function over a longer time than a single
visit. However, this trial cementation should be managed cautiously. On one hand,
removing the restoration for definitive cementation may be difficult, even when
temporary ZnOE is used.
To avoid this problem, the provisional cement can be mixed with little petroleum or
silicone grease and applied only to margins of restoration to seal them while allowing
subsequent removal without difficulty.
On the other hand, a provisionally cemented restoration may come loose during
function.
If a single unit is displaced, it can be embarrassing or uncomfortable for the patient.
If one abutment of a FPD becomes loose, the consequences can be more severe.
If the pat does not promptly return for recementation caries may develop very rapidly.
Provisional cementation should not be undertaken unless the patient is given clear
instructions about the objective of the procedures, the intended duration of the trial
cementation and the importance of returning if an abutment loosens.
TEMPORARY CEMENTATION
Unmodified ZOE cements are used as a luting material for provisional restorations in
crown and bridge prosthodontics.
Unmodified cements are available in the compressive strengths of 1.4MPa to 21MPa.
Studies proved that luting cements with a compressive strength of 15 to 24 MPa was the
most appropriate cement based on retention; taste; ease of removal; ease of cleaning.

NON-EUGENOL PASTE
One of the chief disadvantages of the ZOE pastes is the possible stinging or burning
sensation caused by eugenol when it contacts soft tissues. Furthermore the ZOE reaction
is never completed, with the result that the free eugenol may leach out. Some patients
find the taste of eugenol extremely disagreeable and in patients who wear a surgical pack
for several weeks; a chronic gastric disturbance may result.
A material similar to ZOE reaction product can be formed by a saponification reaction to
produce an insoluble soap, if the zinc oxide is reacted with a carboxylic acid. The
reaction is
ZnO + 2RCOOH (RCOO) 2Zn + H2O
Almost any carboxylic acid reacts with zinc oxide, but only a few such acids provide
compounds of dental interest. Orthoethoxybenzoic acid, (EBA), is used in this regard.
The carboxylic acid is not necessarily a liquid. Powdered acids can be dissolved or
dispersed in a liquid carrying agent, such as ethyl alcohol.
The non-eugenol cements do not adhere well to preformed metal crowns as the eugenol
containing cements, and they are slower setting.
The non-eugenol cements however do not soften provisional acrylic crowns.

RESIN BASED CEMENT


Resin luting cements have been in existence since the 1950s. The early formulations
were lightly filled methyl methacrylate resins. Because of their high polymerization
shrinkage, tendency for pulpal irritation, penchant for micro leakage and poor handling
characteristics, these resins had only limited use.
However , with the development of composite direct filling resins with improved
properties acceptance to acid etch and potential to bond to dentin, a variety of resin
cements have become available.
ISO 4049
Describes three classes of composites for polymer based filling, restoration and luting
materials
Class 1 self cured materials
Class 2 light cured materials
Class 3 dual cured materials
REQUIREMENTS BASED ON ISO 4049
Class 1,2,3: maximum film thickness 50 m
Class 1,3: minimum-working time 60 seconds
Class 1,3: maximum setting time 10 minutes
Class 2: depth cure 0.5mm (opaque) 1.5mm (others)
Class 1,2, 3: water sorption 40 g/mm
Class 1,2,3: solubility 7.5 g/mm

COMPOSITION
The basic composition of the most modern resin based cements is similar to that of resin
based composite filling material. The resin cement consists of a resin matrix (bis-GMA or
diurethane methacrylate) with inorganic fillers that are bonded to the matrix via coating
with an organosilane coupling agent. The filler particle provides strength. The fillers are
those used in composites (silica or glass particles, 10 to 15 m in diameter) and the

colloidal silica is that used in micro filled resins. The resin matrix binds them together
and bonds them to the tooth structure. Because most of a prepared tooth surface is dentin,
monomers with functional groups that have been used to induce bonding to dentin are
often incorporated in these resin cements. They have organophosphates, hydroxyethyl
methacrylate (HEMA), and the 4-methacyrlethyl-trimellitic anhydride (4-META) system.
Bonding of the cement to enamel can be attained through the acid tech technique.
Polymerization can be achieved by the conventional peroxide amine induction system or
by light activation. Some cements are autopolymerising for use under light blocking
metallic restorations, while others are either entirely photo cured or dual cured (light
activated) for use under translucent ceramic veneers and inlays. In dual cured cements, a
catalyst is mixed into the cement so that it will eventually harden within shadowed
recesses after a rapid initial hardening is achieved with a curing light.
Dual cured cements come in a base catalyst form and must be mixed before use.
Light cured composites are photo initiated in the presence of a camphoroquinone amine
system. They provide a wide selection of shades, tints and opaquers.
PROPERTIES
Resin based cements are virtually insoluble in oral fluids.
They are formulated to provide the handling characteristics required for the particular
application for e.g., cements recommended for cementation of indirect restorations have a
film thickness of 25 m or less.
With respect to bonding to dentin, the so-called adhesive cements, which incorporate the
phosphonate, HEMA or 4-META adhesion systems, generally develop reasonably good
bond strengths to dentin. Bonding to tooth structure may be more critical for resin based
cements than for some other types of cement, because they possess no anticariogenicity
potential.
These cements differ from restorative composites primarily in their lower filler content
and lower viscosity. Resin cements are virtually insoluble and are much stronger than
conventional cements. It is their high tensile strength that makes them useful for
micromechanically bonding etched ceramic veneers and pitted partial denture retainers to

etched enamel on tooth preparations that would not be retentive enough to succeed with
conventional cements.
BIOLOGIC PROPERTIES
Resin based cements, just like composite cements are irritating to the pulp. Thus, pulp
protection via a calcium hydroxide or glass ionomer liner is important when one is
cementing an indirect restoration that involves bonding to dentin.
MANIPULATION
The chemically activated versions of theses cements are supplied as two component
systems a powder and a liquid or two pastes.
The peroxide initiator is contained in one component and the amine activator is contained
in the other. The two components are combined by mixing on a treated paper pad for 20
to 30 seconds. The time of excess removal is critical. If it is done while the cement is in a
rubbery state, the cement may be pulled from beneath the margin of the restoration,
leaving a void that increases the risk of plaque buildup and secondary caries.
Removal of the excess cement is difficult if it is delayed until the cement has
polymerized. It is best to remove the excess cement immediately after the restoration is
seated.
Light cured cements are single component systems just as are the light cured filling
resins. They are widely used for cementation of porcelain and glass ceramic restorations
and for direct bonding of ceramic orthodontic brackets. The time of exposure to the light
that is needed for polymerization of the resin cement is dependant on the light transmitted
through the ceramic restoration and the layer of polymeric cement. However the time of
exposure to the light should never be less than 40 seconds.
The dual cure cements are two component systems and require mixing that is similar to
that for the chemically activated systems. The chemical activation is slow and provides
extended working time until the cement is exposed to the curing light, at which point the
cement solidifies rapidly. It then continues to gain strength over an extended period
because of the chemically activated polymerization.

DISADVANTAGES
Excessive cement film thickness
Marginal leakage because of setting shrinkage
Severe pulpal reactions when applied to cut vital dentin
Dentin bonding agents have been reported to reduce pulpal response, presumably by
sealing the dentinal tubules and reducing micro leakage. Adhesive resin was found to
produce better marginal seal than zinc phosphate cement.

COMPOSITE RESIN SYSTEM


Three types of composite resin materials are available for use in indirect techniques:
microfilled resins, small particle composite resins and hybrid resins. All show excellent
wear resistance, but small particle composite resins and hybrid resins can be etched to
produce micromechanical retention. They can also be silanted to increase the bond
strength further. One manufacturer of a reinforced microfilled resin inlay/ onlay system
provides a special bonding agent to increase the bond strength of its material.

RESIN BONDED BRIDGES


Theses prosthesis are widely employed as alternatives to metal ceramic bridges.
In this procedure, the preparation of the abutment teeth is minimal and is confined to
enamel of the lingual surface and proximal surfaces. The tissue surfaces of the abutments
are roughened by electrochemical etching or other means and the surfaces of the prepared
tooth enamel are acid etched to provide mechanical retention areas for the resin cements.
GLASS CERAMIC RESTORATIONS
These restorations are often translucent and require specific shades of cementation agent
to maximize their esthetic appearance.
Resin cements have been the cementation agents of choice recently for all ceramic inlays,
crowns and bridges because of their ability to reduce fracture of the ceramic structures.

To achieve the best retention, the undersurface of the glass ceramic restorations is usually
etched and a silane coating is applied before cementation.
RESIN METAL BONDING
Bonding composites to the metal framework of a bridge and denture acrylic to a partial
denture framework can be improved by the use of silica coating. Presently there are three
methods of applying silica to either noble or base metal alloys.
One method applies pyrogenic silica using a propane flame.
Other method s use heat in an oven or ceramic blasting to coat the restoration or
appliance. Bond strengths of composites to silica coated Au-Pd-Cr-Be alloys from 16 to
22 MPa. Silica coating of noble alloys eliminates the need for tin-plating these alloys to
improve adhesion of composites. The bond strength of denture acrylics to Ni-Cr-Be
alloys range from 7 to 23 MPa when alloy is treated with a silica coating or primed with
adhesive resin cement. Liquid cements based on thiosulfates have recently become
available for treatment of alloys. Recently, metal primers based on thiophosphate
chemistry have been introduced as a treatment for resin metal bonding.

COMPOMERS
Compomer is the resin based cement indicated for cementation of cast alloy crowns and
bridges, porcelain fused to metal crown and bridges and gold cast inlays and onlays.
Cementation of all ceramic crowns, inlays onlays and veneers The cement should not be
used as a core or filling material.
Compomers are also known as poly acid modified composites.
COMPOSITION
The cement powder contains strontium aluminum fluorosilicate glass, sodium fluoride
and self and light cured initiators. The liquid contains polymerizable methacrylate /
carboxylic acid monomer, multifunctional acrylate / phosphate monomer, diacrylate
monomer and water.
SETTING REACTION
Setting is the result of self and light cured polymerization. Once the cement comes into
contact oral fluids an acid - base reaction may occur. The carboxylic acid groups
contribute to the adhesive capability of the cement.
MANIPULATION
Dry the tooth to be cemented but do not desiccate. The powder liquid ratio is 2 scoops to
2 drops. Tumble the powder before dispensing. Mix the powder and the liquid rapidly for
30 seconds. Place the mixed cement in the crown only and then seat the crown.
A gel state is reached after 1 minute, at which time the excess cement is removed with
floss and a scaler. Light cure the exposed margins to stabilize the restoration. Setting
occurs 3 minutes after start of mix. Once set, compomer cement is very hard.
PROPERTIES
Compomer cement has higher values of retention, bond strength, compressive strength,
flexural strength and fracture toughness. The cement has low solubility and sustained
fluoride release.

CEMENTATION PROCEDURE
The permanent cementation of the restoration is the final clinical procedure that marks
the success of our efforts.
Our interest is that the permanent cementation should be performed without long periods
of temporary cementation. Otherwise the patient may be exposed to a series of unpleasant
complications such as separation of the teeth, difficulty in achieving a satisfactory level
of oral hygiene, problems in removal of the restoration, and the possibility of infiltration
because the thickness of the temporary cement is without doubt greater than the thickness
of the permanent cement and is much less fluid.
In immediate cementations the conditions of the healthy periodontium are ideal and
especially in conditions of complete visibility of the entire preparation, cases in which the
provisional restoration has been constructed properly, the only practice we follow is one
of isolating the area, cleaning the preparation and protecting the prepared surface of vital
teeth.
ISOLATION
The performance of all luting agents is degraded if the material is contaminated with
water, blood, or saliva. Therefore the restoration and the tooth must be carefully cleaned
and dried after the try in procedure, although excessive drying of the tooth must be
avoided to prevent damage to the odontoblasts. The casting is best prepared by airbrading the fitting surface with 50m alumina. This should be done carefully to avoid
abrading the polished surfaces or margins. Alternative cleaning methods include steam
cleaning, ultrasonic and organic solvents.
Before initiation of cement mixing, isolating the area of cementation and cleaning and
drying the tooth is mandatory. However the tooth should never be excessively desiccated.
Over drying the prepared tooth will lead to postoperative sensitivity.
SALIVA CONTROL
Depending on the location of the preparation in the dental arch, several techniques can be
used to create the necessary dry filed of operation. In areas where only supragingival
margins are present, moisture control with a rubber dam is probably the most appropriate

method. However, in most instances a rubber dam cannot be used and absorbent cotton
rolls must be placed at the source of the saliva; an evacuator must be placed where the
saliva pools. In the maxillary arch, placing a single cotton roll in the vestibule
immediately buccal to the preparation and a saliva evacuator in the opposing lingual
sulcus is generally sufficient.
When working on a maxillary second or third molar, multiple cotton rolls must be placed
immediately buccal to the preparation and slightly anterior to block off the parotid duct.
If a maxillary roll does not stay in position but slips down, it can be retained with a finger
or the mouth mirror.
An alternative to multiple cotton rolls is placement of one long roll horseshoe fashion
in the maxillary and mandibular muccobuccal folds.
The use of moisture absorbent cards is another method for controlling saliva flow. These
cards are pressed paper wafers covered with a reflective foil on one side. The paper side
is placed against the dried buccal tissue and adheres to it. In addition two cotton rolls
should be placed in the maxillary and mandibular vestibules to control saliva and displace
the cheek laterally.
Svedopter and Speejector for isolation and evacuation of the mandibular teeth, the
metal saliva ejector with attached tongue deflector is excellent. By adding facial and
lingual cotton rolls, excellent tongue control and isolation is provided.

Excessive forces are not necessary to make crowns seat during the phase of cementation.
If the space for the cement has been provided by the use of die spacer, it is not necessary
to exert a great deal force, which can determine a permanent alteration of the integrity of
the marginal fit. It should be kept in mind that the cementation load should not exceed 57 kg.

The technique used is known as the brush technique and consists of the application of a
small quantity of cement on the incisal edge of the preparation using a brush for the
application.

The interior of the crown in the area of the margins is painted with a small quantity of
cement, and the crown is placed along its path of insertion.

The insertional technique is as follows: the crown is inserted slowly to about one half the
distances; it is then withdrawn by a few millimeters and is reinserted to almost the full
extent of its length. The process is then repeated. We use a slight up and down movement
along this path to assist the layering of the cement. When the operator no longer feels any
resistance, the crown is pushed to the finish line and thus to its final seating. It is
necessary to avoid rotational movements to find the correct seating position. This can be
damaging if porcelain margins are present.

Once the crown has been inserted the patient is provided with an occlusal support and is
asked to close to maintain the position of the crown during the setting of the cement.
In professional practice we prefer to cement one crown at a time, or at the most two
adjacent crowns.

Once the cement has hardened we follow this procedure: after immersion of the P.K.
Thomas no. 2 waxing instrument in a silicone lubricant we enter the junctional area and
remove the excess cement by following the anatomy of that area. We prefer to use this
instrument because it has a rounded tip and a curvature that are ideal for following the
anatomic contour. We place it against the coronal surface and insert it in the gingival
sulcus in the junctional area. By applying light pressure we follow the junction and
remove the cement. The purpose of this cement is this technique is to remove the cement
following the contour without causing scratches in the area of crown margin. The same
procedure is repeated on the lingual surface and on the interproximal surfaces, and
because of the instrument curvature; it results as being efficient and easy to perform.

Some cements like polycarboxylate or resin, tend to pull away from the margins if excess
removal is performed too early.
Dental floss with a small knot in it can be used to remove any irritating residual cement
interproximally and from the gingival sulcus. The sulcus should contain no cement. After
the excess has been removed. The occlusion can be checked once more with Mylar shim
stock.
Cements take at least 24 hours to develop their final strength. Therefore the patient
should be cautioned to chew carefully for a day or two.

POST-CEMENTATION
Aqueous based cements continue to mature over time well after they have
passed the defined setting time. If they are allowed to mature in an isolated environment,
that is, free of contamination from surrounding moisture and free from loss of water
through evaporation, the cements will acquire additional strength and become more
resistant to dissolution. It is recommended that coats of varnish or a bonding agent
should be placed around the margin before the patient is discharged.

LUTING OF VENEERS
All ceramic restorations may be cemented with zinc phosphate, glass ionomer or dual
polymerizing resin cement. The cement comes in four shades (A2, C2, B1 & B3)
permitting some influence on the final shade of translucent restorations. This not only
provides better retention and colour control but it makes the ceramic material less fragile
than if it were cemented with non resin cement.
Clean the prepared tooth with non fluoride pumice and try in the porcelain veneers.
Verify the marginal fit. A drop of water or glycerin will help the veneer stay in place. The
restoration should be internally clean, etched and silaned. Remove any organic debris
with ethanol or acetone.

Acid etch the internal surface of the restoration with

hydrofluoric acid (for feldspathic porcelain etching time is 5 minutes).

The gel is

carefully rinsed under running water (this hydrofluoric acid acts as an organic solvent and
helps to remove any residual investment)
Dry the ceramic with oil free air. The silane coupling agent is applied to internal surface
of restorations. Dispense one drop of silane primer and drop of silane activator into
dappen dish. Stir the liquid in the dish for 10-15 seconds with a brush. Apply to etched
porcelain for 1 min and air dry after it.
These silane coupling agents are organosilones which help to form covalent bonds
(methacrylate group) with the resin when it is polymerized. Alternate to it titanates and
zirconates can also be used as coupling agents.
Etch the enamel surface with 37% phosphoric acid rinsed for 20 seconds and air dry the
tooth.
The bonding agent is then applied to the tooth for 30 seconds with a brush and
compressed air is used for 5-10 seconds to remove the excess adhesive
Polymerize the adhesive for 20 seconds with a light source. Dispense equal amounts of
base and catalyst from dual cure resin. Mix for 10-20 seconds with plastic mixing stick.
Apply a thin layer of cement to the internal surface of the crown. Seat the crown and
remove excess cement from the marginal areas with an explorer and clean brush.
Continue polymerizing for an additional 45-60 seconds, directing the light from the
lingual (through the tooth) so that shrinkage will occur toward the tooth. Then direct the

light from the labial (through the veneer). When light activation is not utilized, allow 6
minutes for auto polymerization.
Once the luting agent is polymerized trim the excess cement and check the occlusion.
Final finishing procedures can be accomplished with porcelain polishing agents.

LUTING OF CERAMIC RESTORATIONS WITH RESIN BASED CEMENTS


The crown should be cleaned, etched and silaned. Remove any organic debris with
ethanol or acetone, followed by placing the restoration in an ultrasonic cleaner. Further
cleaning can be accomplished by applying liquid phosphoric acid etchant. The crown is
silaned with a silane coupling agent. Dispense one drop of silane primer and one drop of
silane activator into a dappen dish. Stir the liquid in the dish for 10 -15 seconds with a
brush. Apply it to the internal surface of the crown; avoid application on the external
surface of the crown by covering the outside of the crown with wax. Rinse the crown and
dry it with compressed air.
Clean the tooth preparation with a rubber cup and flour of pumice. Ten wash and air dry.
Etch the enamel for 30 seconds. Rinse and air dry the tooth.
Apply bond adhesive over the entire preparation with a brush. Thin the bonding agent
with compressed air for 15 seconds. Polymerize the adhesive.
Dispense equal amount of base from the syringe and catalyst from the tube. Mix for 10
-20 seconds with a flat ended plastic mixing stick. Apply a thin layer of cement to the
internal surface of the crown. Seat the crown and remove the excess to avoid ditching the
cement at the margin.
Aim the light cure at the marginal areas from facial, lingual and occlusal directions for 40
-60 seconds.
Adjust the bulky margins and check for premature contacts. Polish the crown using
porcelain finishing kit.

CONCLUSION
Luting agents possess varied, complex chemistries that affect their physical properties,
longevity and suitability in clinical situations. It appears a single adhesive will not suffice
in modern day practice. To date, no adhesive can completely compensate for the
shortcomings of the preparation retention and resistance forms or ill fitting, low strength
restorations. Prosthdontics must be aware of the virtues and shortcomings of each cement
type and select them appropriately.

REVIEW OF LITERATURE
Edwin. V in 1951 in his study on mechanism of dental structure said that the dental
cements act as a bond by keying action. Roughness of interface between the inlay and
the tooth area involved (pitch or taper between opposing walls of cavity) thickness of the
bond.
John E. Johnston 1954 did a evaluation of an acrylic cement for one year. He concluded
that acrylic cement is more difficult to remove then ZnPO 4 from cervically, a complete
dehydrated surface is desirable, ability to with stand expansion and contraction due to
temperature charge is not determined yet if the marginal cement is removed and before
polymerization, leaking will occur.
R.W.Phillips (1968) in his article ZNO and Eugenol cements for permanent restoration in
his conclusion was ZNOE was inferior to ZnPO4 in terms of compressive strength.
Wendi A. Levine (1969) did an evaluation of film thickness of resin luting agents. Most
of the commercially available resin luting cements have films thin enough to allow to
successful placement of etched cast metal retainer. Restorative resins which have grater
film thickness are unsatisfactory for use as luting agents.
W.A. Richter (1970) did a study on predictability of retentive values of dental cements.
He concluded that by comparing the tensile strength of ZnPO4 , hydrophosphate and ZOE
are equal and carboxylate is at least one third stronger. In retentive evaluation the
carboxylate, ZnPO4 and Hydrophosphate cements are equal and ZOE is as retentive.
Oilo G(1978) The influence of surface roughness on the retentive ability of two dental
luting cements.Two series of brass cones and two series of dentine posts with varying
surface roughness were produced. Maximum roughness value and arithmetical mean
roughness were recorded for each cone. A tensile stress was applied until the crown and
cone separated. The retentive force is relation to retentive area was measured. The

results showed that the retentive ability of both cements increased with increasing surface
roughness. The increase in retention was greater for bras than for dentine.
Dorothy McComb (1982) did a comparison of glass ionomer cement with other cement of
retention of castings. She concluded that G.I. have the greater retentive strength and Zinc
Phosphate has the weakest strength.

Michael L. Myers (1983) conducted a study on marginal leakage of contemporary


cementing agents, he concluded that the least amount of leakage were shown by ZnPO 4,
than followed by glass ionomer cement with protective varnish and last is
polycarboxylate.
Gudbrand Oilo (1984) did a clinical study of two luting cements used on student treated
patient. In his 6 to 18 months observation there was no difference in both ZnPO 4 and
Polycarboxylate cement, both cement was seen equally suitable as a luting material.
W.R. Lacefield (1985) did a study of tensile bond strength of a glass ionomer cement, he
concluded that the tensile bond strength of G.I. cement to enamel was significantly
greater than to dentin (etched with phosphoric and citric acid has no significantly effect
on temporary bond strength.
G.L.Button (1985) in his article on surface preparation and shear bond strength of the
casting cement interface accounted that air blasting with 60 m aluminium oxide
particles provided the surface roughness and topography with the greatest resistance to
shear stress.
Antony H.L. Tjan (1987) did a comparison of effect of various cementation methods on
the retention of prefabricated posts according to his study the post cemented with
composite recorded the greatest retention, then the ZnPO4 and glass ionomer.

C.L. Davidson (1991) made a study on destructive stresses in adhesive luting cements.
He said that nature and magnitude of the stress development, depend greatly on the
formulation and film thickness of the luting cement. The thicker the layer, the faster the
stress development in the G.I. and slower in the composite. The contraction stress has a
detrimental effect on the corrosive strength of the glass ionomer and on the adhesive
strength of the composite.
R.E. Kerby (1991) compared physical properties of stainless steel and silver reinforced
G.I. Cement, he suggested that the stainless steel reinforced G.I. cement possess strength
properties that should lead to a stronger, more # resistant restorative when compared with
the presently available one.
De Schepper E.J. (1991), Fluoride release form G.I. Cements .This study compared the
amounts and patterns of fluoride release form 11 commercially available glass ionomer
cements into artificial salvia over an 84 day period. The results indicated that the
materials differed in the amount of fluoride released, and that Miracle Mix released the
highest cumulative total of fluoride over the test period. Along with old Fuji II, Miracle
Mix also released the most fluoride during the last time interval (56 to 84 days). All of
the materials released the greatest proportion of their cumulative total fluoride in the first
24 hours after mixing.
Zakia Fakiha (1992) experimented the rapid mixing of ZnPO4 for F.P.Ds., he
experimented mixing of ZnPO4 rapidly in ordinary and frozen glass and compared their
properties. Mixing in frozen glass showed increase in PH, slightly increase in film
thickness, increase in working time and decrease in setting time compared with the
mixing in ordinary glass slab. So frozen glass slab mixing appear to be satisfactory better
for F.P.Ds.
Chung Moonum 1992 experimented the effect of early water contract on G.I., ZnPO 4,
Polycarboxylate luting agents. He found out that the time between start of mixing and

immersion in water decreased the width of both zones in all cements and markedly
lowered the loss of the surface of regular glass ionomer cement than other.
William W. Bracket (1992) analyzed the performance of a glass luting cement over 5
years in a general practice. In 5 years period 1435 received cast restoration luted with
G.I. cement. The material has demonstrated an exceptionally low rate of secondary
caries, excellent retention of castings and acceptable compatibility with the dental pulp.
Johnson H, Powell .L.V (1993) - Evaluation and control of post-cementation pulpal
sensitivity : zinc phosphate and glass ionomer luting cements.Many studies have
documented pulpal sensitivity after crown cementation, but non have determined its
cause.

By controlling technique variable in a large scale clinical trial, the authors

evaluated the contribution of the zinc phosphate and glass ionomer luting cements in
causing pulpal sensitivity or necrosis.
James E. Metz, William. W. Brackett (1994) in their study on performance of G.I. luting
cement over 8 years in a general practice reported as follows 1230 cast restorations luted
with G.I. cement were followed up for 8 years. The result showed :a.

Absence of secondary caries

b.

99% retention of restorations

c.

4 % incidence of irreversible pulpitis

Wu-J.C., Wilson (1994) Optimal cement space for resin luting cements..Stainless steel
dies, simulating 0 to 80 microns of die spacing, were seated into a machined brass crown
with phosphacap, Panavia EX, and C and B metabond. The seating discrepancy after 60
seconds was measured to determine the optimal cement space for best seating for each
agent. The most complete seating for crowns luted with zinc phosphate cement was
observed when at least 40 microns of cement space was provided. C and B Metabond
and Panavia required 30 microns of die spacing.

REFERENCES
1. Antony H. L. Tjan: - Effect of various cementation methods on the retention of
prefabricated - J.P.D. 1987; 58,3; 309
2. Button G.L. Surface preparation and bond strength of casting cement interface.
J.P.D 1985; 53; 134-8.
3. Chung Moonum: - The effect of early water contact on G. I. Cements.
Quint. Int.1992; 23; 209.
4. .Dorothy McComb Retention of castings with G.I. cements
J.P.D.- 1982; 48-3; 285.
5. Davidson C.L.- Destructive stress in luting cements.
J. Dent Res: 1991; 70-5, 880
6. De Schepper E.J. Fluoride release from G.I. cements
Quint: 1991; 22; 3; 2157. Edwin V. - Mechanism of dental structures. J.P.D. 1951,2, 306-10
8. G.H. Johnson Evaluation and control of post cementation pulpal sensitivity
J.A.D.A. 1993; 124; 11; 38-46
9. Gudbrand Oilo Clinical study of two luting cements used on students treated
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10. G.Oilo- The influence of surface roughness on the retentive ability of two dental
luting cements. J.Oral.Rehab; 1978 5(4) 372-89
11. John F. Johnston- Evaluation of acrylic cements.- J.P.D. 1959-5-200-4
12. James E Metz Performance of a G.I. luting cement over 8 yrs in a general
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13. Kerby R.E.- Physical properties of stainless steel and silver forced G.I. cements
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