Dental Cements
Dental Cements
Review Article
Dental Cements - A Review to Proper Selection
John Paul*
ABSTRACT
The number of choices for indirect restorations has evolved greatly over the last
decade. Today proper selection of dental cements is a key factor to achieve a
Keywords successful restoration and will greatly increase the chances of long-term success of
the restoration. In recent years, many newly formulated dental cements have been
Chryseobacterium developed with the claim of better performance compared to the traditional
indologenes, materials. Unfortunately, selection of suitable dental cement for a specific clinical
UTI, application has become increasingly complicated, even for the most experienced
resistant dentists. The purpose of this article is to review the currently existing dental
cements and to help the dentists choose the most suitable materials for clinical
applications.
Introduction
In literature, although the terms cement , According to the expected longevity of the
luting , bond have different meanings, restoration, dental cements can be divided
they have frequently been employed as into 2 groups: provisional (temporary) and
interchangeable terms. Luting refers to a definitive cements. All definitive cements
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However, recent studies found that the bacteria left on the prepared tooth surface.
bonding strength of self-adhesive resin However, in clinical practice, the tooth
cement (RelyX Unicem, 3M ESPE) preparation with low Residual Dentin
remained unchanged when provisional Thickness (RDT) to be cemented with zinc
cement was used previously [14,15]. phosphate cement may suffer from
sensitivity during and after cementation.
Definitive Cement Owing to its lengthy history of use, zinc
phosphate cement is considered as the
In the past (and still), the term permanent gold standard against other definitive
cement has been frequently employed dental cements compared [19].
when describing dental cements for the final
restorations. As a matter of fact, a more 2.Zinc Polycarboxylate Cement
proper description of cement should be
definitive cement when describing a Similar to zinc phosphate cement, zinc
cementation can not be removed at a later polycaboxylate cement is also an acid-base
time [2]. Among cements in this category reaction cement. It is mixed using
are: zinc phosphate cement, zinc polyacrylic acid and a powder containing
polycarboxylate cement, conventional glass- zinc oxide and magnesium oxide [1]. Zinc
ionomer cement, resin-modified glass- polycarboxylate cement, invented in 1968,
ionomer cement and resin cement . was the first cement exhibiting chemical
bond to tooth structure [17]. Its adhesive
1.Zinc Phosphate cement properties produce a weak bond to enamel
and an even weaker bond to dentin (1-2
It is the dental cements having a long-term MPa) through the interaction of free
successful track record of more than a carboxylic acid groups with calcium from
century since its introduction in 1880s [16]. tooth structure [20]. Zinc polycaboxylate
Zinc phosphate cement is mixed using cements exhibit a low compressive strength
phosphoric acid liquid, and powder that is (67 to 91 MPa), and a low tensile strength (8
composed of zinc oxide and magnesium to 12 MPa). It has been reported that zinc
oxide. Even though its use has declined polycarboxylate cement may undergo
remarkably, significant amount of clinical significant plastic deformation under
success makes zinc phosphate cement still dynamic loading after set [21]. This property
readily available in many developing limits the use of zinc polycarboxylate
countries [17]. Zinc phosphate cements lack cement for single unit restoration or short
chemical bond to tooth structure and exhibit span fixed partial denture cementation.
a moderate compressive strength (62 to 101 Perhaps the biggest advantage of this cement
MPa), a low tensile strength (5 to 7 MPa), is the good biocompatibility with the dental
and a high degree of solubility (0.36%). pulp, which could be partially due to a rapid
After being mixed, zinc phosphate cement rise in pH after mixing and lack of tubular
exhibits a low pH of 2. The pH then penetration from the large and poorly
increases and reaches 5.5 after 24 hours. dissociated polyacrylic acid molecule [22].
Despite its low initial pH, Brannstrom and This property has motivated its use as
Nyborg [18] reported that zinc phosphate provisional cement to reduce the possibility
cement has no irritating effect on the dental of post-cementation sensitivity for tooth
pulp and the potential irritant effect of zinc preparations with low RDT. Although zinc
phosphate cement might be due to the polycarboxylate cement has the merit of
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producing a chemical bond to enamel and should be blotted dry with cotton wool. The
dentin, its use has lessened over the years main disadvantage of this cement is
[8]. susceptibility to moisture contamination and
desiccation during the critical initial setting
3.Glass-ionomer cement period [26]. Early exposure to water and
saliva contamination has been shown to
Conventional glass-ionomer cement: significantly increase the solubility and
Glass-ionomer cements were introduced as decrease the ultimate hardness of
hybrids of silicate cements and conventional glass-ionomer cements [27].
polycarboxylate cements to have When working with conventional glass-
characteristics of fluoride release (from ionomer cement, the material at the
silicate cements) and adhere to enamel and restoration margins should be protected with
to some extent to dentin (from a coating agent (e.g., Ketac Glaze, 3M
polycarboxylate cements) [23]. It consists of ESPE) or petroleum jelly [28]. Moreover,
a powder containing aluminosilicates with conventional glass-ionomer cement has
high fluoride content, and a liquid composed relatively low resistance to acid attack and
of polyacrylic acid and tartaric acid. When bleaching so it may not be the proper choice
conventional glass-ionomer cements are for the patients who have gastric reflux
mixed, the polyacrylic acid reacts with the problems or want their teeth to be bleached
outer layer of the particles resulting in [29,30].
release of calcium, aluminum, and fluoride
ions. When a sufficient amount of metal ions 4.Resin-modified glass-ionomer cement:
are present, gelation occurs. Hardening of
the material continues for 24 hours. Resin-modified glass-ionomer cements
Conventional glass-ionomer cements exhibit combine the technology and chemistry of
a low bonding strength to tooth structure, a resin and conventional glass-ionomer
moderate compressive strength (85 to 126 cement. This class of dental cement was
MPa), and a low tensile strength (6 to 7 produced to overcome the two important
MPa). It is noteworthy that the physical weakness of conventional glass-ionomer
properties of conventional glass-ionomer cement, which are sensitivity to early
cement can be highly variable based upon moisture contamination and high solubility
different powder/liquid ratio so the [31]. Resin-modified glass-ionomers were
manufacturer s instruction for mixing should formed by replacing part of the polyacrylic
be followed strictly [24]. One of the main acid in conventional glass-ionomer cements
advantages of convention glass-ionomer with polymerizable functional methacrylate
cement is the constant long-term fluoride monomers. Compared to conventional glass-
release and its fluoride recharging ability, ionomer cement, resin-modified glass-
which are considered beneficial to caries ionomer cement showed improved adhesion
prevention. to tooth structure, higher compressive
/tensile strength, and low solubility to ensure
The bonding strength between conventional the long-term integrity of the margins and
glass-ionomer cement and dentin low possibility of post-cementation
significantly reduces when dentin is sensitivity while maintaining high levels of
excessively dried, which also contributes to fluoride release which is similar to
post-cementation sensitivity [25]. Thus, conventional glass-ionomer cement [32].
before cementation the wet dentin surface Resin-modified glass-ionomer cements
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exhibit moderate bonding strength to tooth Also, some resin cements contain ytterbium
structure (around 8 MPa), good compressive trifluoride or barium aluminium
strength (93-226 MPa) and tensile strength fluorosilicate filler and are capable of
(13-24 MPa). releasing fluoride after setting stage. This
may imply that these types of resin cements
An in vivo study pointed out that the patients offer cariostatic potential [38].
with restorations cemented with resin-
modified glass-ionomer cement Resin cements vary in curing mechanism
demonstrated the least post-cementation (light-cured, self-cured, and dual-cured)
sensitivity compared to the ones cemented [39]. Self-cured and dual-cured resin
with conventional glass-ionomer cement and cements can be used for all cementation
zinc phosphate cement at all different applications. Light-cured resin cements,
intervals of time tested [33]. Setting reaction however, should be limited to porcelain
of this cement is a dual mechanism, which veneers and glass-ceramic restorations that
includes acid-base reaction and allow the curing light to penetrate the
polymerization. When the powder and the porcelain. Some manufacturers claimed that
liquid are mixed, acid base reaction occurs light-cured resin cement had better long-
with the formation of polyacrylate salt. term color stability. However, conflicting
Initiation of polymerization can be triggered results have been reported in the literature
by either light or sufficient free radicals [40,41]. It has been reported that dual-cured
[34]. resin cement showed a reduced bonding
strength and microhardness without curing
5.Resin cement: light [42-44]. Therefore, it is important to
light cure all dual-cured resin cements at all
As an alternative to acid-base reaction accessible restorative margins for enough
cements, resin cements were introduced in time periods.
the mid-1970s [35]. Resin cements are based
on bisphenol-a-glycidyl methacrylate (Bis- As mentioned previously, resin cements can
GMA) resin and other methacrylates, which be divided into 3 subtypes based on bonding
are modified from the composite resin mechanism (total-etch, self-etch, self-
(restorative material). This class of cements adhesive) [39]. The total-etch (etch-and-
has a setting reaction based on rinse) systems have 3 main steps: 1) acid
polymerization. Resin cements have the etching, rinse, gently dried; 2) bonding
advantage of high compressive/tensile/ agents applied, cured; 3) resin cement
bonding strength, low solubility, and applied, cured. For the self-etch systems, the
esthetics [36]. These properties allow them acid etching and bonding steps are replaced
to be employed in cases where there are with the self-etch bonding agent application,
concerns about retention or with weak and which combines the conditioner, primer, and
esthetic restorations (e.g., restorationss made adhesive [7]. The total-etch and self-etch
from glass-ceramic and composite resin). resin cements could be considered as
While previous studies considered high film conventional resin cement . In order to
thickness as one of the major disadvantages improve the ease of use, the self-adhesive
of resin cements, Kious et al. [37] showed resin cements were developed and
all the recently introduced dental cements introduced in 2002. Although this subtype of
meet the ISO standard of film thickness (25 resin cements does not have long-term
microns) for up to 2 minutes after mixing. clinical track record, it is already the most
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popular subtype of resin cements [45]. The material significantly affects the longevity
first product, RelyX Unicem from 3M of a restoration. It is critical that the
ESPE, has been well studied and widely clinicians select the dental cements
used around the world. These cements do considering their physical, mechanical,
not require surface pretreatment and esthetic, and handling properties as well as
bonding agents to maximize their the costs and technique required. Currently
performance [46]. Therefore, the technique resin cements have gained lots of popularity
sensitivity of self-adhesive resin cement has due to their versatility, performance and
been greatly reduced compared to the favorable esthetic properties. However, if
conventional resin cements [47]. However, adequate tooth preparation and resistance
that is not the case for bonding strength form exists or where moisture control may
between self-adhesive resin cements and be problems, more conventional dental
tooth structure/restoration. cements (e.g., conventional glass-ionomer
cement, resin-modified glass-ionomer
All resin cements are relatively insoluble cement) might be a better choice compared
when compared to the dental cements to resin cement.
mentioned previously. They have the highest
mechanical and physical properties as well The high demand for esthetically pleasing
as the cost compared to other currently restorations has resulted in the development
existing dental cements [2,48]. This class of and introduction of various ceramics.
cement has a more tooth-like translucency. Among all the available ceramics, the
In some cases, they are also available in polycrystalline ceramics (aluminum oxide
tooth shades to best match the adjacent and zirconia oxide) are the most popular
tooth. Importantly, for resin-containing materials due to their superior performance.
dental cements (resin cement and resin- Although polycrystalline ceramics are often
modified glass-ionomer cement), polymer cemented conventionally using glass-
degradation over time is still an issue. ionomer cement or zinc phosphate cement,
Mineralized dentin contains matrix they can benefit from adhesive cementation
metalloproteinases (MMPs) and MMPs are with resin cements. In those circumstances
fossilized and activated during bonding application of a primer containing 10-
procedure. The collagen fibers to be bonded methacryloyloxydecyldihydrogen phosphate
might be slowly degraded by the activated (MDP) (eg. DC Bond, Kuraray) before
MMPs, resulting in reduced bonding application of the resin cement has been
stability over time [49]. As a matter of fact, recommended in instances where better
this action is far beyond the control of retention is required [52].
dentists. Pretreat dentin with chlorhexidine
or combination of chlorhexidine and Regarding selection of dental cements for
bonding agents might prevent this action of implant-supported restorations, the
the endogenous enzymes [50,51]. However, practitioners have a broad choice of many
further studies are needed to verify this different dental cements, each with
hypothesis. advantages and disadvantages. Before
making decision, the dentists should answer
Application the questions how much and how long
retention is needed for this particular
Careless selection of the dental cement or restoration. As soon as the answers to these
improper manipulation of the chosen questions are clarified, the decision-making
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