Dental Luting Cement

Dr: MohD Al-Moaleem

1- A binding element or agency used as a substance to make objects adhere to each other.
2- A material that, on hardening, will fill a space or bind adjacent object.

Dental cement provide bond that prevent the restoration from removal, fill the micro-space between the restoration & tooth (dose not contribute to the retention ?).

Function of the dental cement:

To secure the retention of the restoration to the tooth. To seal the gap against fluids and bacteria from the oral cavity.

To act as insulting barrier against thermal and galvanic effect.

Ideal requirements of dental cement (ADA No-8)

Adhesion to the tooth structures Biological compatibility with the pulp High mechanical Properities Low viscosity and high flow Wetting Low film thickness (<25 microns) In soluble in the oral cavity Long working time Esthetic Translucent Easy to remove the excess Anticarogenic effect.

Factors increasing cement spaces:

1- Thermal and polymerization shrinkage of the impression materials 2- Use of a solid cast with individual stone dies 3- Use of internal layer of soft wax 4- Over use of die spacer 5- An increase in the expansion of the investment mold 6- Removal of he metal from the fitting surface.

Factors decreasing cement spaces:

1- Use of resin or electroplate dies 2- Use of alloy with higher melting range 3- Reduced expansion of the investment.

Factors affect the mechanical interlocking bond:

1- Geometrical relation of the preparation (retentive qualities, surface area, taper, length of preparation) 2- The biophysical factor related to casting (fitting accuracy, modulus of elasticity of the metal, surface texture of the inner surface of the restoration) 3- Mechanical property of the luting agent (compressive, tensile, shear strength and film thickness) 4- Differences in the coefficient of thermal expansion (tooth, restoration & cement)

Bonding mechanism of dental cement:

Non-adhesive or mechanical in which cement extended into small irregularities of the

adjoining surface sandblasting and roughening of cast (Zinc phosphate) . Micromechanical: Resin cement holding the restoration by penetrating into small surface pits Molecular adhesion it is true adhesion is the molecule ions exerted between the surface of bodies in contact (Polycarboxylate, GI, RMGI).

Types of dental luting cement

Zinc oxide and egenol ( conventional & modified) -------------- temporary. Zinc phosphate cement Zinc polycarboxylate cement Glass ionomer cement ( conventional & resin modified) Composite resin cement ( conventional & adhesive). permanent

Reinforced zinc oxide and eugenol

1- Adhesion: mechanical 2- Biological compatibility: palliative 3- Mechanical properties: low 4- Solubility: soluble 5- Working time: short can be increased by adding of water? 6- Translucency: not translucent 7- Anticarogenic effect: no 8- Remove the excess: difficult 9- Film thickness: high film thickness.

Mainly used for temporary cement Deterioration faster than other cement in patient mouth Coat the patient tounge, cheek adjacent to teeth to improve clean-up Combined with EBA and reinforced with AL oxide to improve mechanical properties to used as permanent cement (type II).

Zinc phosphate cement

1-Adhesion: mechanical 2- Biological compatibility: irritant 3- Mechanical properties: high 4- Solubility: high soluble (hydrophilic) 5- Working time: long 5 min 6- Translucency: not translucent 7- Anticarogenic effect: no 8- Remove the excess: easy 9- Film thickness: 25 micron.
Post-operative sensitivities due to Initial irritation to pulp (PH 2-305) reduced gradually

after setting to (6.5 at 24 hours) Cementation of conventional crown and posts with good retentive features Low hardness No bond with tooth so need abrading of the cast by sandblasting In multiple restorations, working time can be extend by incremental and cool slab mixing.

Zinc Polycarboxylate cement

1- Adhesion: chemical and mechanical

2- Biological compatibility: good and no adverse effect on pulp (ph 4.8) and lesser penetration through dentinal tubules because large molecular weight of polyacrylic acid 3- Mechanical properties: high tensile strength then zinc phosphate but less in compressive

4- Solubility: yes 5- Working time: very short 2.5 minutes 6- Translucency: no 7- Anticarogenic effect: no 8- Remove the excess: difficult 9- Film thickness: 25 micron.
Molecular bonding to tooth substance (2MPa) Low post-op sensitivities Low hardness and not resist to acid dissolution useful to retain un-retentive provisional crowns.

Glass ionomer cement

GIC, a polyacrylate based translucent cement, was introduced to dentistry in 1972. It attempts to combine the advantages of both silicate and polycarboxylate cements.

1-Adhesion: chemical by molecular bonding to tooth substance and mechanical (3-5MPa) 2- Biological compatibility: good but may cause some post operative sensitivity. 3- Mechanical properties: high with minimal dimensional changes and better compressive strength 4- Solubility: yes sensitive to water and it is contamination with moisture 5- Working time: moderate 3.5 6- Translucency: yes, limited application to ceramics 7-Anticarogenic effect: yes, with fluoride release so crown cementation with high caries index 8- Remove the excess: easy 9- Film thickness: 20 micron 10- Some reported with sensitive cases due to lower PH

RMGI

Molecular bonding to tooth substance or good compressive 85-126 MPa and

tensile strength (13-24 MPa) , high bonding strength Fluoride release Low solubility or resistant to water solubility Good working time Reduced post-op sensitivities (effect on dental pulp) Hybrid with light curing resin (self cured is the most used) Translucency Any restoration with low retentive features

Reported cause of fractures of porcelain because expansion after water absorption.

Resin cement
1-Adhesion: conventional mechanical adhesive mechanical and chemical 2-Biological compatibility: irritant 3- Mechanical properties: excellent 4- Solubility: low 5- Working time: conventional short adhesive controllable 6- Translucency: yes 7- Anticarogenic effect: no 8- Remove the excess: conventional difficult adhesive : easy 9- Film thickness : conventional high adhesive 19 micron
High adhesive quality (18-20MPa) Retention High hardness All metal, ceramic , composite(indirect) with self, light and dual cured Occa. Post-op sensitivities Less viscosity than restorative material

Comparison of available luting agents

Cementation techniques and pre-treatment

Zinc phosphate
Polycarboxylate Glass ionomer

Conventional

RMGI cement
Resin cement

Adhesive

Pre-treatment procedure

Pre-treatment procedure

Cementation techniques

Advantages of conventional cement

Easy handling Moisture tolerance No pre-Tx steps Routine for metal base

Advantages of resin cement

Excellent mechanical properties
High bond strength with pre-Tx step High aesthetics/translucency Suitable for Ceramic, Porcelain, Reinforced Composite and Metal.

Selection of luting cement depending on:

Mechanical properties of cements Biological consideration Bonding mechanism strength Prepared teeth geometry (over prepared tooth) Dissolution in water Film thickness Type of restoration (inlay, partial veneer or full crown)

Selection of luting cement? EXAMPLES

Long bridge: (High mechanical property, long working time and adhesive property)

GI, zinc phosphate or adhesive composite. Patient with high caries index: (cement with fluoride release) GI or adhesive resin Panavia f. Deep preparation (cement palliative and non irritant to the pulp) polycaroxylate and reinforced ZOE. Cementation of free metal restoration: (cement with high translucency, strength and bond to booth restoration and tooth) adhesive resin. Cementation of post: (high flow, adhesive and strength) GI, adhesive resin or zinc phosphate. Cementation of resin bonded bridge or questionable preparation: (cement with high strength, bond to both restoration & tooth and insoluble) adhesive resin.

Post cementation: (high flow, adhesive and strength) GI, adhesive resin or zinc phosphate

Cementation of a restoration to a core: Requirement, adhesion to the core

Composite core----------------------- composite resin Glass ionomer---------------------------- glass ionomer Amalgam-------------------------------------all cement Cast gold--------------------------------- best is zinc poylcarboxylate, and resin cement Non precious inlay-----------------resin, GI, poylcarboxylate

Seven Boo-boos

1- Over contouring 2- No proximal contact 3- Open or over finished margin 4- No occlusal contact 5- Perforation while adjusting the occlusion 6- Occlusion left to high 7- Cement left below the gingiva.

Recommended reading: Fundamentals of Prosthodontics (third edition) Herbert T. Shillinburg, Sumiya Hobo, Lowell Whitsett, Richard Jacobi and Susan Brackett, 1997, Quintessence Publishing Co PP. 400-418