DENTAL CEMENT

Dental Cement
Dental cements application
1- Luting agents ; to bond prefomed restorations and
orthodontic attachments in or on to the tooth
2- Cavity liners and bases\ to protect the pulp[ thermal and
chemical insulators} and as foundation and anchor for restorations
3- Restorative materials {temporary or permanent}
NB|orthodontic application of cements is limted to luting of
appliances such as bands
Ideal requirements of cement
1-Adequate working and setting time
2-High tensile compressive and shear sternght
3-Resistance of dissolution
4-Clinically acceptable bond strength
5-L0w adhesive remnant index and low adhesive remnant
index following debonding
6-Anticariogenic property
Class Ionomer Cement material
Zinc Phosphate Cement. First introduced in 1878,
zinc phosphate cement possesses high compressive
strength (96 to 110 MPa). It exhibits a pH of 3.5 at the
time of cementation and it has been widely blamed for
contributing to pulpal irritation.
Brannstrom andNyborg however, found no irritating effect on thepulp
from zinc phosphate, per se
. Cavity varnishes partially reduce the exposure of the pulp to the
cement but unfortunately they also reduce retention
. Zinc silicophosphatecement
which also has been in use since1878, exhibits a high compressive
strength (152 MPa) and a moderate tensile strength (9.3 MPa).
However, its film thickness can be excessive (88 urn at the occlusal
surface under an actual casting), and it also has an acidic pH that may
be harmful to the pulp.
. Polycarboxylate Cement polycarboxylatecement has a
higher
tensile strength than that of zincphosphate, its
compressive strength at 24 hours is
significantly lower Its pH is also low (4.8), but because
of the large size of the polyacrylic acid molecule there
is apparently little penetration into the dentinal
tubules. a result, it seems to cause little pulpal
irritation. This cement has shown a moderately high
bond strength to enamel (9 MPa) and to dentin (3.3
MPa). Polycarboxylatewill also bond to stainless steel,
but not to gold
Temporary dressing, Zinc oxide Euginol Cement
 Zinc Oxide-Eugenol. Cements
• zinc oxideand eugenol cause virtually no pulpal
inflammation as long as they make no direct contact with
the pulp. Theyhave long been used as temporary cements .
Attemptshave been made to create more
biocompatiblepermanentcements by adding o-ethoxy-benzoic acid
(EBA) tozinc oxide-eugenol and by reinforcing it with aluminumoxide
and poly(methyl methacrylate). Based on in vitrotests, this type of
cement was reported to have good strength and be less solublethan
zincphosphatecement.Unfortunately,
• its clinical performance was much poorer than its laboratory
performance, and in vivostudies have shown that it deteriorates
much more rapidlyin the mouth than do other cements .Zincoxide-
eugenol cements are still used largely for provisional cementation.
 Resin Luting Cements.
Resin cements are composites composed of a resin matrix, eg, bis-GMA diurethane or

methacrylate, and a filler of fine inorganic particles

. They 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 fixed
partial denture retainers to etched enamel on tooth preparations that would not be retentive enough to
succeed with conventional cements
Some of these cements are autopolymerizing for useunder light-blocking metallic restorations, while
others are either entirely photocured or dual cured (light activated) for use under translucent ceramic
veneers and inlays
. In dual-cured cements, a catalyst is mixed into thecement so that it will eventually harden within
shadowedrecesses after a rapid initial hardening is achieved with acuring lightProblems that have been
reported

with the use of resincements for luting fuil crowns include excessive cementfilm thickness,ao69 marginal
leakage because of setting
shrinkage, and severe pulpal reactions when applied tocut vital dentin The latter may be related more to
bacterial
infiltration than to chemical toxicity, however. Use of adentin bonding agent under a resin cement is
critical to
its success, unless the preparation has been cut inenamel. Dentin bonding agents have been reported to
reduce
pulpal response, presumably by sealing the dentinaltubules and reducing microleakage.70 Adhesive resin
cement was found to produce a better marginal seal thanzinc phosphate cement.71 Even if the problems
of film
thickness and microleakage should be solved, the problem
of adequately removing hardened excess resin fromA number of systems have been developed, utilizing
different mechanisms for bonding to the dentinal surface^• Tags in dentinal tubules

• Bonding to precipitates on pretreated dentin• Chemical union with inorganic components• Chemical
union with organic components
• Production of a resin-impregnated layer of dentinIn researching the mechanism of attachment to
toothstructure, it was found that resin tags in excess of 200 }im
were reported when resin was applied to the dentin surfaceof extracted teeth. However, the resin
penetratedonly 10 (im into the dentinal tubules of vital teeth, forming
a resin-reinforced layer of tooth structure, the hybridlayerChemical bonds are subject to degradation
when theyare exposed to the oral environment.71 Microleakage may
occur as a result of bond disruption, causing recurrentcaries, sensitivity, and pulpal necrosis after
restorationplacement.75 The smear layer, a 1- to 5-[im-thick/6 grinding
debris-laden layer of dentin produced during thetooth preparation, is a critical barrier that protects
thetooth from the oral environment
If bonding is attempted directly to the smear layer, however, tensile failure can occur between it and
thecement, or within the layer itself. Therefore, to enhance
bonding to tooth structure, the tooth preparation is usuallyetched. This step alters the dentin surface by
removingthe smear layer, opening the tubules, and increasing
the permeability of the dentin.77 If the smear layer is to beremoved, an effective dentin bonding agent
must beemployed, with true adhesion between the restorative
material and the tooth,72The practice of "total etching" (etching dentin as wellas enamel) was described
by Fusayama et al in 1979.78Caution has been urged in approaching the pulp withacids, utilizing passive
(soaking) rather than active(scrubbing) methods of application and timing theminaccessible margins may
preclude the use of resin
cement for full crowns with subgingival margins.
Hybrid lonomer Cements.
The recently introduced "hybrid cements," or resin-modified potyalkenoate cements,
are purported to combine the strength and insolubilityof resin with the fluoride
release of glass ionomer. They differ from other composite resin cements in that
Iheglass filler particles react with the liquid during the hardening
process. The selection of a cement for the placement of a castrestoration is not a
clear-cut decision. Zinc phosphate isa strong cement that has proven itself over many
years ofuse, outliving numerous would-be replacements. When
depth of the preparation or history of hypersensitivityraises some concern for the
vitality of the pulp, a more
biologically compatible cement, eg, polycarboxylate, should be used. Cement
deteriorates much more rapidly
in some patients than in others.54 If a particular patienthas a history of rapid failure
of previous crowns due to
washout of zinc phosphate cement and marginal carieseuse of a glass ionomer
cement might help prevent recurrenc
Resin cements are indicated where micromechanicalbonding is desired. They are
especially usefulwhen the tooth preparation is largely in enamel and all
finish lines are accessible
• Glproperties of an ideal cement. Glass ionomer has many
• properties of an ideal cement
• powder is composed
• mainly of a calcium fluoroaluminosilicate glass, with fluoride
• content ranging from 10% to 16% by weight.se |n
• some brands the liquid is an aqueous solution of copolymers
• of polyacrylic acid with itaconic or maleic acid and
• tartaric acid. In others the polyacrylic acid or copolymer
• is dried and incorporated into the powder, the liquid consisting
• only of water or a tartaric acid solution.
• Glass ionomer has been in general use as a restorative
• material in Europe since 1975 and in the United States
• since 1977, and has gradually gained in popularity as a
• luting agent. Both its compressive strength (127 MPa)
• and its tensile strength (8 MPa) are quite good.49 Its bond
• to tooth structure is comparable to that of polycarboxylate.
• 57 Bonding of both glass ionomer and polycarboxylate
• cements to the restoration can be produced by tinplating
• the inner surfaces of the restoration. A tin -polyacrylic
• acid product overlying the tin layer on the restoration
• establishes the bond.68
• Glass ionomer cement is bacteriostatic during its setting
• phase,59 is less soluble than zinc phosphate
• cement,55 and releases fluoride at a greater rate than
• does silicate cement. This has been shown to reduce the
• solubility of adjacent enamel and therefore should inhibit
• secondary caries.60 In one study,61 glass ionomer was
• found to be 65% more retentive than zinc phosphate
• cement. In another,6? premolars with inlays cemented
• with glass ionomer were slightly more resistant to fracture
• than were premolars with inlays cemented with zinc
• phosphate.
• Glass ionomer cement is not without its disadvantages.
• Its pH is even lower than that of zinc phosphate cement
• during setting, and some concern has been expressed
• regarding postcementation hypersensitivity.63'64
Because
• the molecules of polyacrylic or polymaleic acid used in
• glass ionomers are large, it is assumed they are less
likely
• than phosphoric acid to penetrate the dentinal tubules,
• and varnish is not generally recommended. A calcium
• hydroxide coating should be applied to areas close to
• the pulp, however.65
• Clinical success with glass ionomer cement depends
• on early protection from both hydration and
dehydration.
• 66 It is weakened by early exposure to moisture, while
• desiccation, on the other hand, produces shrinkage
• cracks in the recently set cement67 Therefore, the
• cement at the crown margins must be protected by a
• coating of petrolatum or varnish.6*5 Glass ionomer is
more
• translucent than zinc phosphate, and this property often
• makes the enamel adjacent to metal castings appear
• slightly gray, particularly on partial veneer crowns
• This material continues to be improved, but its efficacy
• is difficult to assess accurately. Tyas63 sums it up:
• "Because of constant improvements in glass ionomers,
• there have been too few studies on any one material,
• and comparisons between studies are further
complicated
• by differences in evaluation criteria
• carefully.79 Weaker concentrations of acid not only pose
• less of a risk to the pulp, but they also may produce
• greater bond strengths/6 Solutions of 10% phosphoric
• acid are preferable to those containing nearly 40%.eo
• Other etchants effectively used include a 2.5% solution of
• nitric acid81; a 10% citric acid, 20% calcium chloride
• solution82; and a 10% citric acid, 3% ferric chloride solution,
• called simply "10-3," which dissolves a thin layer of
• calcium on the surface of the dentin without affecting the
• collagen.33 Each system requires a particular acid, so
• always use the one specified for the dentin bonding
• agent you are using.
• There is controversy about the use of acids, because
• pulpal damage has been attributed to their application
• near the pulp.84'85 Kanca813 interprets the pulpal irritation
• as being caused by the eugenoi used as a cavity sealer
• in earlier studies, rather than by the phosphoric acid
• itself. Brannstrom87'88 and Cox et al89 also have questioned
• a link between sensitivity and toxicity. Instead they
• conclude that it is the result of bacterial infection.
Phosphate-Based cements\\1-zinc phosphate cement 2-zinc polycarboxylate cements

1-Zinc phosphate cement