Proper selection of luting

cements

Dr.Salah abdel azim

PHD Fixed Prosthodontics
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Requirements of an ideal luting

cement
Ideal luting cement
Biological
1.Biocompatible.
2.Anticariogenic.
3.No microleakage.
4.Easy removal of
excess cement.

Mechanical
1.High strength.
2.Low solubility.
3.Adhesiveness.

Esthetic

Workability

1.Translucency. 1.Acceptable working

2.Color stability. time.
3.Radiopacity.
2.Low film thickness.
3.Low viscosity.

Classification of luting cements

Cements
Provisional
1.ZnO Eugenol cements.
2.Non Eugenol ZnO.

Definitive
Non-Adhesive
1.Zinc phosphate.
2.Reinforced ZnO Eugenol.
3.Conv. Composite resin.

Adhesive
1.Zinc Polycarboxylate.
2.Glass Ionomer.
3.Resin modified G.I.
4.Adhesive resin cement.

Zinc oxide eugenol

Unmodified type used for provisional cementation.

Biocompatible, have palliative and sedative effect.
Low strength properties allowing non traumatic removal of
restorations.
Soluble due to elution of eugenol.
Not translucent, and no anticariogenc effect.
Because eugenol acts as an inhibitor for free radical
polymerized materials, select other material for provisional
restorations when bonding of the permanent restoration is
anticipated.
Non eugenol ZnO cements are also available for provisional
cementation, it contains ZnO and aromatic oil, these
cements are also useful for eugenol sensitive patients. They
are also used with acrylic provisional crowns because they
do not soften the crown.
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Reinforced Zinc oxide eugenol

Reinforced ZnO eugenol cements are used for definitive
cementation either by the incorporation of a polymer or by
the addition of alumina to the powder to the eugenol liquid..
However with these additives;
1) Inferior mechanical properties.
2) High film thickness.
3) Difficult removal of excess.
4) Difficult to manipulate in the oral cavity.
*For these reasons the use of ZnO eugenol as definitive
cement has been confined to those situations in which it was
anticipated that sensitivity might be a problem and good
inherent retention is also available.

Zinc Phosphate

Adequate compressive strength but low tensile.

Early achievement of strength properties.
Acceptable film thickness.
Easy removal of excess.
Moderate to high working time.
Good flow, viscosity rises during setting.
Adhesion: Only mechanical.
High acidity at time of placement. [Varnish application]
No antibacterial effect.
Soluble in oral fluids.
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Zinc Phosphate
Special

mixing method:

Zinc Phosphate

Frozen glass slab method: Higher strength properties.

More working time.
Less pulp irritation.
Greater resistance to solubility.

*Slaking the fluid by incorporating small amount of powder

into the liquid about 1minute before the main mixing is
started will increase working and setting time.

Zinc Polycarboxylate

Excellent Biocompatibility.
Adhesion to tooth structure through chelation of calcium by
the carboxyl grp. of polyacrylic acid. Lower adhesion to
dentine compared to enamel due to lower inorganic content
and presence of smear layer.
Adhesion to base metal alloys and amalgam.
No adhesion to gold or porcelain. Tin plating of gold alloys
and sandblasting to improve it.
Low film thickness despite their viscosity i.e pseudo plastic.
Increasing shear rate of mixing cause thinning.
Lower compressive strength but higher tensile strength and
modulus of elasticity compared to Zinc Phosphate cements.
More difficult to remove excess than ZnPh.
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Decreased working time.

Zinc Polycarboxylate

Powder is added quickly, in large quantities.

Mixing using plastic spatula is preferable.
Mix should be used when still glossy to obtain proper
adhesion.

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Zinc Polycarboxylate

To achieve good adhesion tooth surface should be clean, a

recommended method is to apply 10% Polyacrylic acid for 10
to 15 sec. then rinsing by water to remove smear layer.
Reducing powder liquid ratio will increase solubility
dramatically. [by threefold]
A modification of the normal composition is the water
based, where liquid is distilled water and the acid is dried
and added to the powder. Longer working time is obtained.

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Glass Ionomer

Anticariogenic effect due to fluoride release.

Mechanical and Chemical adhesion to enamel and to a lesser
degree to dentine, strong bond to base metal alloys specially
after sandblasting with 50 microns Alumina. Doesnt adhere
to porcelain or gold alloys.
Low film thickness.
Easy removal because it develops brittle properties.
Relative biocompatibility. [no effect on pulp if remaining
dentin thickness is at least 1mm]
Somewhat translucent due to presence of glass. Refractive
index similar to enamel and dentine.
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Glass Ionomer

High solubility initially. [Varnish application]

Susceptible to moisture contamination. Should be protected
with a foil or resin coat or by leaving a band of cement
undisturbed for 10min.
Very sensitive to desiccation as well which can lead to post
cementation hypersensitivity.
Adequate compressive and tensile strength, low modulus of
elasticity but reaches ultimate properties slowly.
Short working time. [increased by using cool glass slab
technique or with water settable types]
Water settable types are available where the acid is dried
and incorporated into the powder, the liquid is distilled
water or dilute conc. of tartaric acid in water.
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Glass Ionomer

Post cementation hypersensitivity

Post cementation hypersensitivity thought to be due to

desiccation or bacterial contamination rather than irritation
from the cement itself.

How

to decrease it?

1) Slight hydration of the tooth before cementation by

placing a drop of water on the tooth during mixing which is
gently blown off just before restoration application.
2) Allowing the cement to set hard to the touch plus one
minute before excess removal.
3) Placing a varnish on the margins of the restoration after
excess removal.
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Resin modified Glass Ionomer

R.M.G.I were introduced in an attempt to combine some of

the desirable properties of G.I [Fluoride release and
adhesion] with the high strength and low solubility of resins.
Rapid development of mechanical properties, same
compressive strength and tensile strength as G.I but
increased fracture toughness.
Less susceptible to early moisture contamination than G.I.
Fluoride release. [Anticariogenic]
Early Ph acidic (3.5) and gradually rises.
Minimal post operative sensitivity.
High flow. Initial slow rise in viscosity with a subsequent
increase.
Longer working time.
Bond strength to dentin more than G.I. (17Mpa)
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No measured solubility in acids.

Composite resin cement

These types of filled resin cements replaced the unfilled

resin types due to their superior properties. Composite
resin cements are classified according to their bonding
mechanism to tooth structure into conventional and
adhesive cements.
Conventional type do not form chemical bond to tooth
structure or restoration, i.e mechanical bonding only.
Adhesive type contains a chemically active component which
reacts with both the tooth and the restoration, i.e adhesion
is mechanical as well as chemical.
Excellent mechanical properties.
CRC is the only insoluble cement in oral fluid.
Translucent and has excellent esthetic.
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Composite resin cement

Short working time (conv.), controlled (adhesive) e.g Panivia.

High film thickness (conv.), low (adhesive, 19microns)
Viscosity: increases gradually.
Easy removal of excess (adhesive), difficult (conventional).
Conv. and adhesive types are both irritant to the pulp.

*Bonding of Adhesive CRC to restorations:

It is adhesive to silanated porcelain, composites and the

oxide layer of metal surface.
For non-precious alloys (NiCh and CoCh), they should be
sandblasted with 50microns oxide powder.
For precious alloys, gold alloys should be sandblasted then
tin plated (0.2>>0.4 layer of tin). The cement bonds to tin
oxide layer which develops on the tin plated surface.
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Enamel bonding
Bonding to enamel is achieved by acid etching which causes:
1) Cleaning the enamel surface.
2) Increasing the surface energy.
3) Increasing the surface area by micro tags formation.
(length 15>>>20microns, width 15microns)
4) Mechanical interlocking through these micro tags.
N.B Recently enamel can be etched by Laser such as Carbon
dioxide or Nd:YAG laser.

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Dentine bonding
Problems

facing bonding to dentine:

1) Dentine is heterogeneous, even more than enamel.

2) High protein content leading to low surface energy.
3) Presence of smear layer.
4) Presence of water film from dentinal tubules.
5) Fear of pulp affection due to its proximity.

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Cementation of long span bridges

*Cement requirements:
1)Long working time.
2)High mechanical properties.
3)Preferably to be adhesive.
*Cements of choice:
1)Glass Ionomer. 2)R.M.G.I
3)Zinc Phosphate.
4)Adhesive comp. resin. (Panavia with controlled setting time)
N.B Zinc Polycarboxylate cements are not used due to its
extremely short working time, ZnO eugenol cements are not
used do to their low mechanical properties and short
working time.
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Cementation to deep preparations

*Cement requirement:
Should be non irritant and palliative to the pulp.
*Cement of choice:
1)Zinc Polycarboxylate.
2)Zinc oxide eugenol.

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Cementation in caries active patients

*Cement requirement:
Must have anticariogenic effect by releasing fluoride ions
and inhibiting secondary caries.
*Cements of choice:
1)Glass Ionomer.
2)Resin modified Glass Ionomer.
3)Composite resin releasing fluoride. (e.g Panavia F)

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Cementation to questionable preparations

*Cement requirements:
1)Adhesive.
2)Extremely high mechanical properties.
3)Insoluble.
*Cement of choice:
Adhesive composite resin cement with pulp
protection over very deep dentinal tubules.

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Cementation of Non-Precious &

Precious alloy restorations
*Non-Precious alloys:
Adhesive resin cement, Glass Ionomer, R.M.G.I and
Zinc Polycarboxylate provide good adhesion to
non-precious alloys, especially after sandblasting.
Zinc Phosphate is also used.
*Gold alloys:
Zinc Polycarboxylate cements showed a bond
strength 4 times greater than Zinc Phosphate and
is directly proportional to copper present in the
alloy.
Surface should be blasted then tin plated before
using the adhesive composite resin cement.
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Post crowns cementation

*Cement requirements:
1)High flow.
2)High strength properties.
3)Preferable to be adhesive.
*Cements of choice:
1)Resin modified Glass Ionomer.
2)Glass Ionomer.
3)Zinc Phosphate.
4)Adhesive composite resin. (great care about the
working time)
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Cementation to core based materials

*Cement requirements:
Adhesion to the core material.
*Cements of choice: (According to core material type)
1)Amalgam core: All currently used cements can be used. It is
recommended to use high copper amalgam core with high tin
concentration with polycarboxylate cement since the high
tin conc. enhances the bonding between amalgam cores and
polycarboxylate cements.
2)Composite resin core: Composite resin cement.
3)Glass Ionomer core: Glass Ionomer or R.M.G.I cement.
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Cementation of Ceramic Laminate veneers

*Cement requirements:
1)Translucent.
2)Adhesive to tooth and porcelain.
3)Early high mechanical strength and fracture toughness.
*Cements of choice:

Composite resin cement.

N.B Glass Ionomer cement although it is translucent but has

the disadvantage of slowness with which ultimate
properties are developed. So when subjected to
masticatory stress elastic deformation of the underlying
cement could result in fracture of the brittle ceramic.
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Cementation of Ceramic Laminate veneers

*Porcelain surface treatment:
1)Acid etching 2 to 10% Hydrofluoric acid gel. (Glass ceramics
by 10% ammonium difluoride gel). Acid etching produces
surface layer micromechanical retentive surface due to
preferential dissolution of the crystalline portion of the
ceramic.
2)Silane coupling agent (adhesion promoter) is used to enhance
the chemical adhesion of the resin cement to ceramic
material. Silane is bifunctional material, with one end of the
molecule capable of reacting with an inorganic surface
(ceramic) and other end with an organic surface (resin).

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A.Ceramic surface (etched and silanated)

B.Unfilled resin.
C.Resin luting agent.
D.Etched enamel
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Cementation of Porcelain
laminate veneers

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Thank you.

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