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Australian Dental Journal
The official journal of the Australian Dental Association
Australian Dental Journal 2011; 56:(1 Suppl): 67–76

doi: 10.1111/j.1834-7819.2010.01297.x

A clinically focused discussion of luting materials

EE Hill,* J Lott*
*Department of Care Planning and Restorative Sciences, University of Mississippi School of Dentistry, Jackson, Mississippi, USA.

ABSTRACT
A luting agent’s primary function is to fill the minute void between an indirect restoration (definitive or provisional) and
tooth (or implant abutment) and mechanically lock the restoration in place to prevent dislodgement during function. The
purpose of this paper is to provide a clinically focused discussion on the broad spectrum of luting materials currently
available to help the general practitioner make appropriate choices. Resins are typically formulated for a specific function or
restoration and offer strength, aesthetics, flexible working times, and very low solubility yet are technique sensitive,
expensive and often hard to clean-up. Glass-ionomers offer good strength and optical properties plus the potential for
fluoride release ⁄ recharge but may have short working times, are sensitive to moisture or dehydration early on, and take time
to fully set. Resin-modified glass-ionomers are hybrid, dual-phase materials which are manipulated like glass-ionomer but
set quicker and are stronger. Zinc phosphate cement, used successfully for over a century to lute well-fitting metal and
metal-ceramic definitive restorations, is a very inexpensive, rigid material which displays very high early compressive
strength yet acidity and solubility can be problems. Polycarboxylate cement (a hybrid of zinc phosphate) has lower
compressive strength but high tensile strength and may be less injurious to the pulp. Zinc oxide eugenol and zinc oxide non-
eugenol cements typically have good sealing abilities but their relatively low compressive and tensile strengths, inherent
brittleness, and high solubility limit usage to provisional restorations or implant supported crowns. Claims for multi-
purpose or universal use by manufacturers can be somewhat confusing and overwhelming. Even so, the busy general
practitioner must have sufficient knowledge to help choose an appropriate luting agent for each unique clinical situation.
Keywords: Cements, luting agents, biomaterials, resins, glass ionomer.
Abbreviations and acronyms: RMGI = resin-modified glass-ionomer; ZOE = zinc oxide eugenol.

variety of indirect restorative options available and

INTRODUCTION
Dental restorations are either direct (a material placed
into a prepared cavity as a soft mass which hardens) or
indirect (a solid object fabricated outside the mouth and
placed in or on a prepared tooth). Regardless of
fabrication method or accuracy of fit, an indirect
restoration must be sealed with a ‘luting agent’. Its
primary function is to fill the minute void between the
tooth preparation (or implant abutment) and restora-
tion and to mechanically lock the restoration in place to
prevent dislodgement during function. Depending on
the expected longevity of the restoration, a luting agent
may be considered to be definitive (long term) or
provisional (short term).1
At the beginning of the 20th century porcelain jacket
crowns were made on amalgam dies and the lost wax
technique for fabricating metal restorations was in its
infancy. Luting agent selection was very simple, either
weak thermoplastic gutta-percha, or rigid zinc oxide
based cement was used depending on the retentive
need.2 A century of technological progress increased the
ª 2011 Australian Dental Association
luting agents were developed to address strength,
solubility, and aesthetic concerns.1 An extensive 2003
literature review indicated that loss of retention,
recurrent caries, and aesthetics are very low frequency
post-treatment clinical complications for either single
crowns or fixed partial dentures.3 Those findings serve
as a testament to the relatively high rate of clinical
success for modern luting agents which include: resin,
glass-ionomer, resin-modified glass-ionomer, polycarb-
oxylate, zinc phosphate, zinc oxide eugenol and zinc
oxide non-eugenol cements. Even so, the selection of
the wrong luting agent or improper manipulation of the
correct cement can significantly affect an indirect
restoration’s longevity.
Ideally, luting agent selection should be based on the
specific needs of each clinical situation and every
restorative dentist should have a thorough knowledge
of all available options. Unfortunately, the rapid
proliferation of luting products and claims for multi-
purpose use by manufacturers can be somewhat
confusing and overwhelming. Thus, the busy general
67
 18347819, 2011, s1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/j.1834-7819.2010.01297.x by CAPES, Wiley Online Library on [04/01/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
EE Hill and J Lott

practitioner may limit his ⁄ her usage to only a few

Zinc polycarboxylate
materials based on ease of use, convenience and
familiarity.4

cement
4
Several excellent reviews have appeared in the recent
dental literature which provide in-depth background
information on requirements, chemical nature, mecha-
nism of action, and indications for various luting
agents.1,5–8 The purpose of this paper is not to repeat

Zinc phosphate
comprehensive information but rather to provide a

cement
clinically focused discussion to help the general prac-

4
4

4
4
4

4
titioner make appropriate choices from the many luting
materials now available. A summary table of the
authors’ recommendations is provided to help simplify

glass-ionomer cement
the decision-making process (Table 1). Because of their

Resin-modified
current popularity and importance, definitive contem-
porary materials (resin, glass-ionomer and resin-mod-

4
4

4
4
ified glass-ionomer) will be discussed first before
turning our attention to more conventional and provi-
sional luting cements.

Glass-ionomer
Definitive luting agents

cement
4
4

4
Resins
Resin luting agents are unique in that a polymer matrix
forms to fill and seal the tooth-restoration gap whereas
Dual-affinity

other luting choices are true cements derived from

4
4
mixing a powder and liquid which form a hydrogel
matrix.1 Methyl methyacrylate based resin luting
agents appeared in the early 1950s and were chemically
comparable to direct acrylic filling materials of the
Self-adhesive

time. As such, they did not adhere to tooth structure,

4
4

4
4

4
underwent considerable polymerization shrinkage, had
a relatively high coefficient of thermal expansion,
Resin cements

absorbed water which contributed to microleakage at

etch-bond, resin

the tooth-resin interface, and excess removal was

One-Step

difficult. An extremely low solubility was their only

4
4

*Eugenol containing provisional cements may decrease bonding.

superior physical characteristic compared to other
Table 1. Suggested uses of definitive luting agents

definitive luting cements.9

Modern resin cements are a huge part of today’s
dental product market due to their versatility, high
etch bond, resin

compressive and tensile strengths, low solubility and

3-Step total

very favourable aesthetic qualities. Their major short-

4
4

4
4

comings are: difficult excess removal; technique sensi-

tive; a restoration which has to be removed may have to
be removed in pieces rather than intact; and they are
relatively expensive per unit dose.1 Many manufactur-
Provisional cement precautions*

ers have added fluoride to claim anticariogenic proper-

Alumina or zirconium crown

Cast or pre-fab metal post

ties and to be competitive with glass-ionomers. The

All-ceramic (silica) crown

value of added fluoride to resin has not been fully

All-metal crown ⁄ onlay

Ceramic inlays ⁄ onlays

Metal-ceramic crown

Cantilever prostheses
Poor retentive crown

Resin-bonded FPDs

determined at this time and it has been suggested that

Type of restoration

FPD, short span

when fluoride toothpaste is used the anticariogenic

Non-metal post
FPD, long span

potential of a luting agent to reduce secondary caries

may not be relevant.10
Veneers

As mentioned previously, resin luting agents form

polymers, not cement, but the term ‘cement’ is com-
68 ª 2011 Australian Dental Association
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Luting materials

monly used to reflect the material’s function (to bind a

restoration to tooth structure) rather than its chemistry.
Although many improvements have been made, their
chemistry is basically that of current resin-based
composite direct filling materials whereby a silica or
glass particle-filled polymer matrix seals and provides
mechanical retention for the restoration. If the tooth is
etched and a bonding agent is used and the restoration
is etched or air abraded the retention becomes ‘micro-
mechanical’ which takes greater advantage of the
resin’s high tensile strength.11
Resin luting agents are primarily designed and
indicated for specific clinical situations where their
positive qualities are needed most, i.e. to bond aesthetic
all-ceramic or lab processed resin restorations or
veneers; for luting metal or metal-ceramic restorations Fig 1. A highly opaque resin cement was used to lute these premolar
to tooth preparations that have reduced retention and veneers in an attempt to match the high value anterior metal-ceramic
resistance form (i.e. short tapered crown preparations fixed partial denture.
or resin-bonded fixed partial dentures); and for dowel
(post) cementation in endodontically treated teeth.12 porcelain restoration should be done carefully follow-
These materials are frequently categorized by mecha- ing the manufacturer’s instructions because it is possi-
nism of matrix formation: (1) self- or auto-curing; (2) ble to over-etch and have a lower than optimal bond
light activated-curing; and (3) dual-curing. Four divi- between resin and ceramic.16 Since dentine is the
sions can also be recognized based on bonding proce- primary tooth substrate for full coverage restorations,
dure and ⁄ or use: (1) total etch, bond, plus resin; (2) milder etching with a single step etch-bond agent is
one-step etch-bond, plus resin; (3) self-adhesive resin; preferred followed by cementation with a light acti-
and (4) dual-affinity adhesive resin. vated or dual-cured resin depending on the opacity of
Etched, silane coated porcelain veneers are ‘luted’ to the ceramic (division 2 above) [example products:
a curved enamel surface and it is extremely important Multilink (Ivoclar Vivadent, Amherst, NY, USA),
that the enamel be properly etched to maximize the Clearfil Esthetic Cement (Kuraray Medical, Tokyo,
strength of the micromechanical bond. A light activated Japan)]. Excess removal for these types of cement is
resin luting system which involves separate etching of usually done after a very short (2 to 5 seconds) light
enamel (and dentine), followed by application of a cure with final curing completed after initial clean-up.
bonding agent and cementation with resin is preferred Care must be taken during the initial bulk removal of
(division 1 above) [example products: Ultra-Bond Plus excess resin cement to insure the material is not pulled
(Den-Mat, Santa Maria, CA, USA), Variolink II from under the restoration margin, creating a gap or
(Ivoclar Vivadent, Amherst, NY, USA), Calibra (Dents- void (Fig 2).
ply, York, PA, USA)].13 Most of these cements have
water soluble try-in pastes which are intended to match
the cured resin but that is not always true so a trial
sample of the set cement should be compared to the try-
in paste prior to luting to help insure the desired
aesthetic outcome. Opaque shades are also available to
help mask dark tooth structure or to mimic less
translucent adjacent metal-ceramic restorations
(Fig 1). Dual-cure resins should be used cautiously for
luting veneers because they may discolour with time
due to their aromatic amine content.14
All-ceramic crowns, inlays and onlays made from
silica-containing materials which etch with hydrofluoric
acid (those without alumina or zirconia cores) also
benefit from resin bonding. Based on multiple bench
and clinical studies looking at fracture resistance and
sealing, it is postulated that resin bonding helps diffuse
Fig 2. Care should be taken during the initial (bulk) removal of excess
stress and eliminate microcrack propagation on the resin cement to insure material is not pulled from underneath the
internal aspect of porcelain restorations.15 Etching of a restoration margin.

ª 2011 Australian Dental Association 69


EE Hill and J Lott
All-ceramic crowns and fixed partial denture retain-
ers made with high strength alumina and zirconia core
materials do not need to be strengthened by resin
bonding but may have visible margins or fit discrepan-
cies and can benefit from using aesthetic, tooth shade,
resin cement. It should be recalled that porcelain
margins round to a degree during firing and various
all-ceramic systems differ in their quality of marginal
fit.17,18 Therefore, more cement exposure may be
anticipated for all-ceramic (or resin) restorations as
compared to metal or metal-ceramic restorations and
solubility, resistance to wear, and aesthetics all dictate
the use of resin cement. Because these ceramics are
relatively opaque, either dual- or self-curing resin
cement should be used.
When delivering metal or metal-ceramic restorations
where luting agent strength and low solubility may be
high priority issues, auto-curing self-adhesive, auto-
mixed or pre-encapsulated, resin luting agents may be
useful (division 3 above) [example products: G-Cem
(GC International, Tokyo, Japan), SmartCem2 (Dents-
ply Caulk, Milford, DE, USA), RelyX Unicem
(3M ESPE, Pymble, NSW, Australia), Maxcem Elite
(Kerr, North Ryde, NSW, Australia)]. Although a
recent 38-month clinical study showed one product
(Rely X Unicem) performed as well as zinc phosphate
for luting metal-based fixed partial dentures, there is
little long-term clinical data to support a general
recommendation for their routine use.19,20 If adequate
preparation and resistance form exists or where mois-
ture control and clean-up access may be problems,
more conventional luting agents (glass-ionomer, resin-
modified glass-ionomer or zinc phosphate) are often a
better choice.
Resins are often promoted for dowel (post) cementa-
tion in endodontically treated teeth.12,14 The use of a
resin luting agent would seem reasonable if a resin core
is to be placed to allow chemical bonding between
exposed cement and core material. Light or dual-cured
resins are not recommended for metal or opaque fibre
post cementation due to the uncertainty of sufficient
curing before the core is subjected to stress (including
tooth preparation and provisional crown removal).
(Remember, the sole purpose of the post is to help
retain the core.) Three-step etch and rinse or two-step
self-etch resin bonding systems are preferred to lute
posts (rather than single-step, self-etching ⁄ self-priming
resin cements) to optimize adhesion of the resin cement
to dentine lining the canal space.12 Luting of a cast metal
post or titanium post where an amalgam core will be
placed can be accomplished with resin but zinc phos-
phate may be a better choice due to its longer working
time, rigidity and extremely high early strength.1,21
Dual-affinity adhesive resins (those that bond to both
tooth structure and various restorative materials)
(division 4 above) [example products: Imperva Dual
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(Shofu, Kyoto, Japan), Panavia F 2.0 (Kuraray Medi-
cal), Super Bond C&B (Sun Medical, Shiga, Japan),
C & B Metabond (Parkell, Edgewood, NY, USA)]
should be considered to be a very specialized group of
resin cements. They require a three-step procedure
(etch, bond and resin) as do the materials in our first
division and display similar physical characteristics but
they are uniquely different in that they have been
chemically modified to have very high tensile strengths
and tenaciously bond to etched enamel and electrolytic
etched or micro-abraded base metal and noble metal
alloys. Bonding to tooth structure is very technique
sensitive and bonding to metal varies with the alloy and
is enhanced with the use of special metal primers.1,22,23
Some have investigated the use of dual affinity resins
to bond alumina or zirconia core ceramic restorations
after surface modification to facilitate their use on teeth
with short or over-tapered clinical crowns. Surface
modification of these core ceramics with air abrasion
followed by the use of adhesive phosphate monomers
or silane coating has shown some promise but may
possibly weaken zirconium.24 Palacios et al.25 reported
that composite resin bonding (using Panavia F 2.0
(Kuraray)) of zirconium copings to extracted teeth was
no more effective in enhancing retention than using
resin-modified glass-ionomer or a self-adhesive resin
cement.
There is a learning curve for using these materials
and manufacturer’s instructions should be followed
explicitly for best results.1 Because they are relatively
expensive, technique sensitive, and clean-up can be
extremely difficult, the use of dual-affinity adhesive
resins should typically be reserved for luting resin-
bonded fixed partial dentures or crowns and conven-
tional partial dentures where other luting agents may or
have provided insufficient retention (Fig 3).
To reap the full adhesive benefits from resin bonding
agents which are used with many of the resin cements
Fig 3. Dual affinity resin cements should typically be reserved for
luting resin-bonded fixed partial dentures or crowns ⁄ conventional
partial dentures where other luting agents may or have provided
insufficient retention.
ª 2011 Australian Dental Association
 18347819, 2011, s1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/j.1834-7819.2010.01297.x by CAPES, Wiley Online Library on [04/01/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
Luting materials

discussed above, the tooth should be thoroughly

cleaned with pumice or prophy paste using a rubber
cup to remove residual provisional cement and debris
prior to luting. If possible, the use of eugenol containing
provisional cement should be avoided when resin (and
resin-modified glass-ionomer) will be used as the
definitive luting agent since residual eugenol may
decrease the effectiveness of some bonding agents.
The use of various cavity cleansers [example products:
Concepsis (Ultradent Products, South Jordan, UT,
USA), Tubulicid (Global Dental Products, North Bell-
more, NY, USA)] prior to etching or application of self-
etching bonding agents has given both negative and
positive results depending on the product and bonding
agent combination.26

Glass-ionomer cement
Glass-ionomer (glass polyalkenoate) cement [example
products: AquaCem (Dentsply), Ketac Cem (3M ESPE),
GlasIonomer (Shofu)] was formulated in 1969 by
Wilson and Kent and by the late 1990s had become
the most frequently used definitive luting agent world-
wide. Its popularity has been attributed to ease of Fig 4. Glass-ionomer and resin-modified glass-ionomer must be used
mixing, good flow properties, adhesion to tooth before loss of the glossy appearance.
structure and base metals, cariostatic potential due to
fluoride release (as well as fluoride recharge potential), so the manufacturer’s instructions for measuring should
good translucency, adequate strength, and relatively be strictly followed for optimal results.21 The use of
low cost per unit dose.1,27 It is primarily indicated for self-contained mixing capsules (as provided by
luting metal and metal-ceramic restorations although it 3M ESPE for Ketac Cem) helps eliminate this variable
can be used with high strength core (alumina or (Fig 5).
zirconium) all-ceramic crowns.1 Two other negative traits of glass-ionomer cement
The setting reaction for glass-ionomer cement (as for are its past association with the occurrence of tooth
all dental cements except resin) is an acid-base reaction. sensitivity after restoration delivery and high early
In this instance, a fluoride containing aluminosilicate solubility. The tooth for which the restoration is
glass reacts with poly(alkenoic acid)s to form a hydrogel intended should be dry but not excessively and the
matrix. Although the reaction appears simple, it is not. restoration should be seated with firm finger pressure
The cement undergoes an initial snap set then continues
to mature going through several overlapping stages
which may take up to several months to reach comple-
tion.28 The snap set requires the restoration be quickly
and fully seated before the material loses its glossy
appearance (Fig 4). If needed, the working time can be
extended by handmixing on a cooled (but not moist)
glass slab.29 The length of time required for complete
setting to occur coupled with a modulus of elasticity
(degree of stiffness) that is less than zinc phosphate (the
traditional standard for luting cements) may suggest that
its use be limited to single unit restorations (inlays,
onlays, crowns) and short-span fixed partial dentures
(i.e. areas of limited functional stress).1 It is not
recommended for luting posts because vibration from
further tooth preparation may reduce the definitive
mechanical retention provided by the cement.
Fig 5. Encapsulation helps ensure accurate proportioning and mixing
Physical properties of glass-ionomer can be highly of cement (left to right: Unicem (3M ESPE), KetacCem (GC), Fuji
variable depending on the powder ⁄ liquid mixing ratio Plus (GC)).

ª 2011 Australian Dental Association 71


EE Hill and J Lott
Fig 6. When using glass-ionomer or resin-modified glass-ionomer the
restoration should be seated with firm finger pressure while main-
taining a dry field.
(Fig 6). The patient should not close on a cotton roll or
stick (a common practice used with viscous zinc
phosphate) to help avoid saliva contamination of the
setting cement. Exposure to saliva, blood or water must
be avoided to prevent loss of cement at the restoration
margin for ideally 7 to 10 minutes after mixing (Fig 7).
Extended dryness should also be avoided to prevent
possible dehydration which can result in microcracking
within the material.1,30
It was assumed that early reports of sensitivity after
restorations were luted with glass-ionomer were due to
the material’s initial low pH which quickly rises upon
setting. Several studies have shown the problem has a
multifactorial origin and that traumatic manipulation
(desiccation, over preparation, exposure to acidic
retraction cord, etc.) of a vital tooth is typically the
cause.1,21,31 To help avoid post-delivery sensitivity it is
Fig 7. Glass-ionomer must be protected from moisture exposure
ideally for 7 to 10 minutes to reduce cement loss due to early solubility.
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recommended that the substrate tooth be carefully
cleaned (very light or no pumicing) to maintain the
smeared layer and the tooth surface be dry but not
dehydrated.1,26 Placement of a resin-based sealer prior
to cementation may also reduce the possibility of
sensitivity for deep dentinal preparations and can
enhance the retention of the cement.32
Resin-modified glass-ionomer cement
Resin-modified glass-ionomer cement (RMGI) (resin-
modified glass-polyalkenoate) is just what the name
implies, it is a hybrid material derived from adding
water soluble polymers or polymerizable resins to
conventional glass-ionomer cement [example products:
Fuji Plus (GC), Rely X Luting Cement (3M ESPE),
Dyract Cem (Dentsply)]. These ‘hybrids’ were created
in the 1980s in an attempt to overcome the two
important weaknesses of conventional glass-ionomer
cement (low early strength and high solubility). Upon
mixing, two unique reactions occur; the resin phase
polymerizes quickly (either by chemical or light initi-
ation) and the glass-ionomer phase proceeds slowly
toward normal maturation via an acid-base reaction
over an extended period of time.1
In general, fully set RMGI cements have superior
physical and mechanical properties compared to con-
ventional glass-ionomers. A very important character-
istic retained from glass-ionomer is the cariostatic
potential due to fluoride release along with the capa-
bility for recharge from topical fluoride. Even so,
studies have shown that higher strength and lower
early solubility may be offset to a degree by some loss of
adhesion to tooth structure and a propensity for
dimensional change due to uptake of water by the
resin phase. Because of the possibility of hygroscopic
expansion, these cements are not recommended for
luting all-ceramic restorations that are susceptible to
etching or posts.30 They are primarily indicated for
luting metal and metal-ceramic restorations and have
been shown to be safe, aesthetic and highly retentive
when used with high strength alumina or zirconium
core all-ceramic crowns.1,33,34
Clinically, mixing and manipulation of RMGI is very
similar to conventional glass-ionomer; cleaning of the
tooth is the same (the smeared layer should not be
removed by heavy pumicing).26 The cement should be
mixed closely following the manufacturer’s directions
on a glass slab or mixing pad (if not pre-encapsulated)
and the restoration quickly seated with firm finger
pressure while the material has a glossy appearance. As
soon as the cement begins to harden (snap set), removal
of excess should begin (especially in interproximal
areas). Excess removal must be done quickly (or
removal can be extremely difficult) and carefully so as
not to pull material out from under the restoration
ª 2011 Australian Dental Association
 18347819, 2011, s1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/j.1834-7819.2010.01297.x by CAPES, Wiley Online Library on [04/01/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
Luting materials

margins.29 As for glass-ionomer, the tooth should be

well isolated and the material kept dry for 7 to 10
minutes to minimize loss of cement at the margins due
to early solubility. The working times for RMGI and
glass-ionomer cements can be quite variable so famil-
iarity with using each material (or product) is important
to prevent incomplete seating of the restoration. When
in doubt, a trial mix is highly recommended.

Zinc phosphate
Zinc phosphate cement has been used for over a century
to successfully seal and retain metal inlays ⁄ onlays and
crowns as well as metal-ceramic and feldspathic
Fig 8. Zinc phosphate cement should be mixed over a broad area on a
porcelain jacket crowns [example products: Fleck’s cool glass slab by bringing small increments of powder into the mix
Zinc Phosphate Cement (Mizzy, Cherry Hill, NJ, USA), over 60 to 90 seconds to help control the viscosity.
Hy-Bond Zinc Phosphate Cement (Shofupore), Zinc
Phosphate Cement (SS White, Lakewood, NJ, USA)]. It
is probably the best choice for cementation of a
prefabricated post when an amalgam core sub-structure
will be placed or for a cast metal post-core because of
its high early strength.35 Owing to its lengthy clinical
history, zinc phosphate cement serves as the standard to
which other definitive luting agents are compared and
remains a very useful luting agent for many well-fitting
indirect restorations.1
As for other true cements, zinc phosphate sets by an
acid-base reaction and its physical properties are
sensitive to several mixing variables (powder-liquid
ratio, water content, mixing temperature, etc.). In
general, when compared to other luting materials, its
compressive strength is relatively high and tensile
Fig 9. When the mixing spatula lifts zinc phosphate away from the
strength is low and it is very inexpensive per unit dose. glass slab by 2–3 cm (about 1 inch), the material is ready for luting.
It is a very stiff material and may be a good choice to
consider when luting long span fixed partial dentures or
cantilevered prostheses. It holds solely by mechanical to 3 cm (Fig 9), it is placed in or on the restoration
retention and does not bond to tooth structure. The which is seated on a clean, dry tooth with firm steady
liquid is buffered phosphoric acid so the mixed material pressure that should be maintained for several minutes
reaches the tooth at a very low pH which quickly rises. to prevent pressure rebound. The initial set occurs
As such, the smeared layer should be maintained to about 5 to 9 minutes after mixing and the clinician
keep penetration into dentinal tubules to a minimum should not hasten to remove excess cement for at least
and a vital tooth should be cleaned with very light or no several minutes after the initial hardening to reduce the
pumicing.26 The placement of two coats of cavity risk of saliva contact because the material is very
varnish or a resin sealer after tooth cleaning may help soluble in the non-matured state.36
reduce the potential negative effect on a vital pulp.
Zinc phosphate is always supplied as two batch Zinc polycarboxylate
matched bottles of powder and liquid which should not
be interchanged with other similar kits from either the Zinc polycarboxylate (zinc polyacrylate or zinc polyal-
same or different manufacturers. Mixing for luting is kenoate) cement was developed by a British researcher,
done on a cool but dry glass slab with the powder DC Smith, in the late 1960s and enjoyed great
brought into the liquid in small increments spreading popularity over the following decade [example prod-
with a spatula over a broad area for 60 to 90 seconds ucts: Durelon (3M ESPE), Poly F Plus (Dentsply), Hy-
(Fig 8). This routine facilitates maximal powder incor- Bond Polycarboxylate Cement (Shofu)]. It was the first
poration while keeping the viscosity low enough for the dental cement that would adhere to tooth structure and
material to flow sufficiently to allow the restoration to was recommended for use with well-fitting metal and
fully seat. When lifting the spatula strings the mixture 2 metal-ceramic restorations.1,28
ª 2011 Australian Dental Association 73

EE Hill and J Lott
In original form, the powder was primarily zinc oxide
(similar to zinc phosphate) and the liquid was a solution
of polyacrylic acid. Later, the liquid became a complex
mixture of several organic acids (polyalkenoic acid).28
Handmixing takes about 30 to 60 seconds and may be
accomplished on either a glass slab (which may be
cooled to extend the working time) or a paper pad, but
unlike zinc phosphate, half to all the dispensed powder
should be incorporated into the liquid at one time.
Viscosity decreases as the rate of spatulation increases
and the correct consistency for luting is when the
spatula pulls up the mix but it strings back by its own
weight; setting time is about 7 minutes.36 One product
currently available, Durelon (3M ESPE), is sold pre-
measured and encapsulated ready for mixing.
Like zinc phosphate, the pH of zinc polycarboxylate
is very low when the tooth is first exposed to the cement
but penetration into dentinal tubules by the high
molecular weight acid is considered to be minimal (if
the smeared layer is maintained) and the histological
response of the pulp is typically good. Compared to
zinc phosphate cement, its early compressive strength is
lower but the tensile strength is much higher and it has
some adhesion to tooth structure although retention is
primarily mechanical.36 Zinc polycarboxylate is some-
what different than the previously discussed true dental
cements in that it may undergo significant plastic
deformation under dynamic loading for a long time
after cementation which may suggest its use be limited
to single unit restorations or short span fixed partial
dentures. (This property has motivated some clinicians
to occasionally use zinc polycarboxylate for luting non-
metal provisional restorations where maximal retention
is needed.) Also, it has relatively low resistance to
erosion in an acidic environment so it may not be the
best choice as a luting agent for patients who have
gastric reflux problems or frequently consume acidic
beverages.28
Provisional luting agents
Zinc oxide eugenol
Zinc oxide eugenol (ZOE) reacts with eugenol via a
complex acid-base type reaction to give a cement which
has been used many years for luting provisional
restorations [example products: TempBond (Kerr),
TempoCem (DMG, Hamburg, Germany), Embonte
(Dux Dental, Oxnard, CA, USA)]. The zinc oxide used
in this cement must be prepared differently than that
intended for zinc phosphate so the materials are not
interchangeable. Formation of ZOE cement is unlike
other aqueous dental cements in that an accelerator
(commonly acetic acid) must be present and exposure
to water hastens the set.28 Setting time may vary
considerably depending on the age of the eugenol
74
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component. As provisional cement, ZOE is commonly
dispensed as two pastes where equal parts are mixed
until uniform in colour and working time varies greatly
from product to product but is typically only a few
minutes (a warm moist environment greatly reduces the
setting time). Retention provided by ZOE for metal
provisional crowns is typically proportional to the
compressive strength which may or may not be true for
non-metal crowns because the eugenol has a softening
effect on the inner surface of acrylic crowns.36
Although the set material has excellent sealing
ability, the physical properties (compressive strength,
tensile strength, solubility, etc.) are so low in compar-
ison to previously discussed cements that ZOE is not
commonly used for luting definitive restorations. These
materials also experience considerable creep and flow
under pressure even when fully set. Reinforcement
using rosin, polystyrene, and poly(methyl methacrylate)
have produced a few products marketed for definitive
luting that still demonstrate relative low physical
properties compared to other cements.28,36
In an attempt to improve the properties of ZOE
cement, in the late 1950s, 2-ethoxybenzoic acid was
added to form what is known as EBA modified ZOE
cement [example product: SuperEBA (Bosworth, Sko-
kie, IL, USA)]. Numerous other modifications resulted
in materials which were overall ‘stronger than the
strongest reinforced ZOE cements’ but an inherent
brittleness and high solubility make their selection for
definitive luting an unwise choice except for extremely
well-fitting metal restorations placed on very retentive
preparations.28
Zinc oxide non-eugenol
Because eugenol is toxic if placed in direct (or very
near) contact with pulpal tissue and other adverse
patient reactions have occurred (although rare) plus the
presence of residual eugenol has an inhibitory effect on
resin bonding, zinc oxide non-eugenol cements were
developed [example products: TempoCem NE (DMG),
Nogenol (GC), PreVISION CEM (Heraeus, Chats-
wood, NSW, Australia)].1,37,38 Retaining zinc oxide
as the primary powder ingredient, a wide variety of
organic acids have been substituted for eugenol to form
dental cements that are not strong enough to be used
for definitive luting but satisfactorily seal and retain
well-fitting provisional restorations. Their chemistry is
so diverse and dental research is so slow that real time
general statements about their physical properties and
clinical performance cannot be made.
Resin
A relative recent proliferation of resin provisional
cements offer the promise of materials that do not
ª 2011 Australian Dental Association

cause some problems associated with ZOE and have
higher retentive capabilities [example products:
TempBond Clear (Kerr), Sensitemp (Sultan, Hacken-
sack, NJ, USA), Temporary Resin Cement (Mizzy,
Cherry Hill, NJ, USA)]. Lawson et al. reported that
flexure strength correlated with retention for three
resin-based provisional cements and that they
were more retentive when tested against five other
ZOE and zinc oxide non-eugenol cements.40 Very
little independent research has been conducted on
these materials. As a precaution, a resin-based sealer
should not be placed to help control tooth sensitivity
(a relatively new practice sometimes done after tooth
preparation and before impression-making) to
avoid possible bonding of the resin provisional
cement to the preparation.26 Non-scientific compara-
tive internet shopping indicates these materials may
be more expensive than other provisional luting
agents.
How do you select a luting agent for an implant
supported restoration?
The basic function of a luting agent for an implant
supported crown is to hold the restoration in place for
‘x’ amount of time which is primarily determined at
delivery. There are those who say that if an implant is
ideally placed and the occlusion will be optimal (i.e.
functional forces are directed only along the long axis
of the implant) then an implant supported crown
should be cemented with a relatively strong, definitive
material such as resin, zinc phosphate or resin-modified
glass-ionomer.1
There are also times when removal of an implant
supported crown may be desirable to re-torque or
tighten an abutment screw or facilitate cleaning of
joined restorations so that a weaker, provisional
luting material such as zinc oxide eugenol may be a
better choice. Because connected implant components
do not flex in function (as do teeth) and the fit
between metal implant abutments and crowns is
usually very intimate, many clinicians have found
that relatively weak luting agents can function for an
indefinite period of time for these restorations. Sheets
et al. examined the retentive nature of various
common luting agents along with several products
sold specifically for use with cement-retained implant
supported crowns and found retention provided for
metal test crowns, in general, paralleled compressive
strength for most materials (i.e. resin > zinc phos-
phate > resin-modified glass-ionomer > etc.).41 The
answer to our question (How do you select a luting
agent for an implant supported restoration?) is based
on those unique factors that a clinician uses to decide
how much and how long retention is needed for a
particular restoration.
ª 2011 Australian Dental Association
18347819, 2011, s1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/j.1834-7819.2010.01297.x by CAPES, Wiley Online Library on [04/01/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
Luting materials
CONCLUSIONS
Delivery of an indirect restoration involves selection of
a material to seal and hold the restoration in place for
the time required for service. Many factors besides the
luting agent (preparation height, taper, oral hygiene,
habits, etc.) determine a restoration’s longevity but
none come into play as quickly as the physical qualities
(strength, adhesion, solubility, etc.) of the luting agent.
A few materials discussed above fulfil most of the basic
requirements of either a definitive or provisional luting
agent yet each has unique shortcomings that may
prevent their universal usage. The busy general practi-
tioner need not (and cannot) know every minute detail
of all the materials discussed above but must have
sufficient knowledge to help choose an appropriate
luting agent for each unique clinical situation.
DISCLAIMER STATEMENT
The authors do not endorse or have any financial
interest in any of the products or companies mentioned
in the text.
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Address for correspondence:
Professor Edward E Hill
Department of Care Planning and Restorative Sciences
University of Mississippi School of Dentistry
2500 North State Street
Jackson, Mississippi 39216
USA
Email: EEHill@umc.edu
ª 2011 Australian Dental Association