LUTING AGENT

I. Introduction
Numerous dental treatments necessitate attachment of indirect
restorations and appliances to the teeth by means of a cement. These
include metal, resin, metal-resin, metal ceramic, and ceramic restorations,
orthodontic appliances; and pins and posts used for retention of
restorations.
The term LUTING is often used in textbooks to describe the use of a
moldable substance to seal space or to cement to components to!ether.
These different applications make "aryin! demands on manipulati"e
properties, orkin! and settin! times, resistance to mechanical breakdon,
and to dissolution. Thus some materials are better suited to some
applications than others. #ecause one type of cement is unlikely to perform
satisfactorily under all conditions, specific cements must be selected and
de"eloped for each applications.
II. Basic considerations:
The discrepancies of fit arisin! durin! the fabrication process for the
inlay or cron, the preparation of the tooth lea"es a rou!h and debris
co"ered surfaces. The cement lute then must ha"e the ability to et the
tooth and restoration, flo into the irre!ularities on the surfaces it is
$oinin! and fill in and seal the !aps beteen the restorations and the tooth.
#ecause an exposed cement line at the restorations mar!in is
ine"itable % especially ith todays restorati"e materials the cement must
&
also ha"e ade'uate resistance to dissolution in the oral en"ironment. It
must also de"elop an ade'uately stron! bond throu!h mechanic
interlockin! and adhesion. (i!h stren!th in tension, shear, and
compression are re'uired, as ell as !ood fracture tou!hness to resist
stresses at the restoration tooth interface.
Good manipulation properties includin! ade'uate orkin! and
settin! time are essential for successful use. The manipulation, includin!
dispensation of the in!redients, should allo for some mar!in of error in
practice. The material must be biolo!ically acceptable.
)s the literature says the oldest established and most idely used
types of dental cements.
&. *inc phosphate and
+. *inc oxide-,u!enol ere de"eloped in the late nineteenth century
and early tentieth century. )lthou!h they ha"e under!one
considerable technical impro"ement, in principle they ha"e
remained almost unchan!ed for -. years. most clinical techni'ues
and e"aluation criteria are based on lon! experience ith these
materials si!nificant research on ne cements has been carried out
only in the last +- years.
The ad"ent of acrylic resins led to the de"elopment of fine !rained
cold curin! polymethyl methacrylate cements in the /id &0-.1s. 2uch
materials did not become popular for routine cementation. /ore recently,
cements based on the #I2-G/) monomer of #oen ha"e become
a"ailable in poder to li'uid 3filler monomer4 form and to paste forms.
)ll these materials set by polymeri5ation mechanisms, so the handlin!
+
'ualities are different and !enerally less satisfactory than con"entional
cements. )nother problem ith resin cements that has limited their use is
the potential tissue reaction to residual monomers in the set material.
None of the fore!oin! cements shos si!nificant adhesion to clean
enamel and dentin. The need for !ood ettin! and bondin! and lo
toxicity led to the de"elopment of cements based on the reaction of
polymeri5e or!anic acids and metal ions in the mid &06.s by 2mith. The
early carboxylate 3or polycarboxylate4 cements ere based on 5inc oxide
and an a'ueous solution of polyacrylic acid or its co-polymers later ork
by 7ilson and cooskers resulted in the !lass ionomer cements that utili5e
non-leachable !lasses rather than 5inc oxide. 8e"elopment in this area still
proceedin!.
)s a result of the research of the last fe years there are no
a"ailable cements of four basic types, classified accordin! to the matrix
formin! species.
&. 9hosphate bonded.
+. 9henolate bonded
:. ;arboxylate bonded and
<. /ethacrylate 3resin4 bonded
7ithin each cate!ory are se"eral classes and this multiplicity
to!ether ith the choice of se"eral brands of material in each class, has
lead to confusion amon! clinicians as to hich type of cement is most
suitable to a !i"en situation. )lthou!h there are national 3)8), )N2I,
#2I, )2)4 and international 3I2=, >8I4 standards for cements, these are of
limited "alue in predictin! clinical durability. )nother difficulty is that
:
reports in the literature are often based on the testin! of one or to brands
of a cement type, and the results are then assumed to apply to all such
cements. It is therefore appropriate to briefly re"ie the characteristics of
the a"ailable cements.
III. Types of cement
1. Phosphate based cements.
a. *inc phosphate cement ? It is the oldest of the cementation a!ents
ha"in! a idest ran!e of application and terms is the one that has
the lon!est track record. It ser"es as a standard by hich neer
systems can be compared. It consists of poder and li'uid in to
separate bottles.
Composition and chemistry: the main ingredients of the powder are:
a. *inc oxide 30.@4.
b. /a!nesium oxide 3&.@4.
The in!redients of poder are sintered at temperature beteen
&...A; and &<..A; into a cake that is subse'uently !round into fi"e
poders. The poder particle si5e influences settin! rate. Generally, the
smaller the particle si5e, the faster the set of the cement.
The li'uid, contain phosphoric acid, ater aluminium phosphate and
in some instances, 5inc phosphate. The ater content of most li'uids is
::@B-@. The ater controls the ioni5ation of the acid, hich in terms
influences the rate of the li'uid poder 3acid base4 reaction.
It is ob"ious that because ater is critical to the reaction, the
composition of the li'uid should be preser"ed to ensure a consistent
<
reaction. ;han!es in composition and reaction rates may occur either
because of self de!radation or by ater e"aporation from the li'uid. This
means that chan!es in the composition can affect the reaction. 2elf
de!radation effects are best detected as a cloudin! of li'uid o"er time.
Properties? the lon! persistence of 5inc phosphate cements in clinical
practice indicates that reasonable performance is obtained. )lthou!h the
properties are far from ideal they are usually re!arded as a standard a!ainst
hich to compare neer cements. The principal reasons for their
satisfactory performance under routine conditions are that they can be
easily manipulated and that they set sharply to a relati"ely stron! mass
from a fluid consistency.
)t standard lutin! consistency the poder to li'uid ratio is +.- to :.-
3! per ml4. The cementin! mix flos readily under pressure to a film
thickness beteen +. and <. mm, hich is ade'uate to seat most types of
restorations as in practice the space beteen the restoration and the tooth
may ran!e upto as much as &.. mm. The film thickness achie"ed in
specific clinical situations is a function of the rheolo!y of the cement and
the !eometry of the surface bein! cemented.
)t the recommended poder to li'uid ratio, the compressi"e
stren!th of the set 5inc phosphate cement is C.D.&&. /9a after +< hours.
The stren!th is stron!ly and almost linearly dependent on poder to li'uid
ratio. The tensile stren!th is much loer than the compressi"e stren!th, -
to E /9a and the cement shos brittle characteristics.
The modulus of elasticity 3stiffness4 is about &: G9a. )ccordin! to
the standard method, the solubility and disinte!ration in distilled ater
-
after +: hours may ran!e from ...<@ to :.:@, for inferior material the
standard limit is ..+@.
The comparati"e e"aluation a cement solubility under clinical
conditions has shon si!nificant loss, but conflictin! results. 8issolution
contributes to mar!inal leaka!e around restorations and bacterial
penetration.
)t room temperature 3+& to +EA;4 the orkin! time for most brands
at lutin! consistency is : to 6 minutes the settin! time is - to &< achie"ed
by use of a cold 3fro5en4 mixin! slab, hich permits upto an approximately
-.@ increase in the amount of poder, impro"in! both stren!th and
resistance to dissolution. The cement has been found to contract about
..-@ linear !i"in! rise to slits at the tooth cement and cement restoration
interface.
Retention: 2ettin! of the 5inc phosphate cement does not in"ol"e any
reaction ith surroundin! hard tissues or other restorati"e materials.
Therefore primary bondin! occurs by mechanical interlockin! at interfaces
and not by chemical interactions.
Prologic effects? the freshly mixed 5inc phosphate is hi!hly acidic ith a
p( of &.6 to minutes after mixin!. ,"en after settin! at & hr the p( may
still be belo <. after +< hrs the p( reaches 6 to E.
=ne material that has a lo acid content and incorporates calcium
hydroxide has little effect on the pulp hen used as a linin!. Fery thin
mixes ill also lead to etchin! of the enamel. The etchin! may assist
mechanical interlockin! to the ad$acent substrates.
6
Adantages and disadantages:
The main ad"anta!es of the 5inc phosphate cements are that they
can be mixed easily and that they set sharply to a relati"ely stron! mass
from a fluid consistency. unless the mix is extremely thin 3for instance,
ith a "ery lo poder to li'uid ratio4 the set cement has a stren!th that is
ade'uate for clinical ser"ice, so their manipulation is less critical than ith
other cements.
(oe"er, then distinct disad"anta!es include pulp irritation, lack of
antibacterial action, brittleness, lack of adhesion, and solubility in acid
fluids.
!odified "inc p#osp#ate cements
Fluoridated cements? 2ome phosphate cements contains fluoride in the
form of stannous or other fluorides.
- 7hich ha"e lo stren!th and hi!her solubility rate.
- They used in orthodontic bracket cementation.
Copper cements: they come impro"es oxide 3red4 or cupric oxide 3oxides4
or copper salts added to the 5inc oxide poder.
- They ha"e !ermicidal action.
Silicophosphate cements: These materials that are combination of 5inc
phosphate and silicate cements ha"e been a"ailable for many years.
The principal applications ha"e been for the cementation of fixed
restorations especially porcelain, because of their translucence.
E
- They are !ermicidal as they contain little amount of mercury
or sil"er compounds.
$omposition and setting: the poder in these materials consists of a
combination of silicate !lass and 5inc oxide, the silicate !lass contains &:
to +-@ fluoride. The li'uid is similar to silicate li'uids containin! about
-.@ (
:
9=
<
; <@ *n and +@ )l the set cement seems likely to consist of
unreacted and 5inc oxide particles bonded to!ether by an alumino
phosphate !el containin! 5inc, ;a, )luminium and >louride ions.
Properties? 9oder to li'uid ratio is +.& to :.+! per ml.
>lo properties of the mix are not as !ood as per *inc 9hosphate
contents, leadin! to a hi!her film thickness in practice.
;ompressi"e stren!th to set cement is &:- to &E- /pa better than
*inc phosphate.
Tensile stren!th is E /pa.
These materials appear to be tou!her and more abrasion resistant
from phosphate cements.
2olubility in distilled ater after E days is hi!her than for *inc
phosphate cements, but under clinical conditions it is less so.
Biological effects: The set cement is much more translucent than the
opa'ue *inc phosphate. Thus it has been used for the cementation of
porcelain restorations.
C
#ecause of the acidity of the mix and the prolon!ed lo
9( 3<&..-4 after settin!. (ence pulp protection is necessary on all
"ital reduced teeth.
Adantages and %isadantages? The silicophosphate cements ha"e better
stren!th and tou!hness properties than the *inc phospate cements, sho
considerable flouride release, transulcence and, under clinical conditions,
loer solubility and better bordin!.
%isadantages include less satisfactory mixin! and rheolo!ic properties,
leadin! to hi!her film thickness in practice and !reater potential for pupal
irritation. They are but suited to cementation of orthodontic bands and
restorations on non "ital teeth. Inau!uration
P&EN'LATE ( BA)E% $E!ENT)
There are three main types of cements under this classification?
&4 The simple *inc oxide % ,u!enol.
+4 Geinforced *inc oxide % ,u!enol.
:4 ,#) cements.
*+ ,inc o-ide ( Eugenol cement:
;ompositon and settin!? The basic combination of *inc oxide and
,u!enol finds it principal applications in the temperory fillin! of teeth, and
as a ca"ity linin! in deep da"ities.
The poder is *inc oxide, ith additi"es such as silica,
may be present. Upto &@ *inc acitate, chloride, sulfate, or other salts
may be present in accelerate the settin!.
0
The li'uid is purified ,u!enol in some cases, oil of clo"es
3C-@ ,u!enol4.
It may contain about &@ of acetic acid or alcohol to
accelerate settin! to!ether ith small amounts of ater.
The cement sits by a chelation reaction beteen to basic
components in"ol"in! the formation of *inc eu!enolate. (oe"er, the
reaction is re"ersible, the *inc ,u!enolate bein! easily hydroly5ed by
moisture ,u!enol and *inc hydroxide. Thus the cement disinte!rates
rapidly hen exposed to oral conditions.
Properties: The material is easy to mix but re'uires a lon! spatulation
time at least 0. seconds.
#ecause of ork nature of bindin! a!ent, the compressi"e
stren!th is lo, ran!in! from E /pa 3lutin! consistency4 to <. /pa
3fillin! consistency)4.
Tensile stren!th is much loer.
The solubility of the set cement in distilled ater is hi!h
hen exposed directly to oral conditions, the material maintains !ood
sealin! characteristics despite a "olumetric shrinka!e of ..0@ and a
thermal expansion of :-x&.
-6
Hde!ree ;.
Biologic effects? The presence of ,u!enol in the set cement under clinical
conditions appears to lead to an anodyne and abundant effect on the pulp in
deep ca"ities.
&.
The seatin! capacity and antibacterial action appears to
facilitate pulpal healin!.
Reinforced ,inc o-ide ( Eugenol cements
$omposition and setting: These materials contain &. to <.@ of finely
di"ided natural or synthetic resins added to or coated on to the poder
particles. )dditional accelerator 3*inc acetate, chloride, or acetic acid4
may be present as ell as antimicrobial a!ents such as thymol or C-
hydroxy!hinoline.
Properties:
7orkin! time is about - mts. and settin! E to 0 mts. Lly to
*inc phosphate.
;ompressi"e stren!th % :- to -- mpa and
Tensile stren!th % < /9a and
/odulus of elasticity is % + to :... Gpa.
The mechanical properties are reduced by impression in
ater, resultin! in loss of ,u!enol. This tendency seems less
pronounced ith the polymer % reinforced materials.
Biological Effects? There may be irritation to connecti"e tissue.
Adantages and disadantages:
Advantages % /ain ad"anta!e is the minimum reaction to the pulp.
Good sealin! properties
&&
The stren!th is ade'uate as a linin! material and for lutin!
sin!le restorations and retains ith !ood retention form.
Disadvantages - /ain is hydrolic break don hen exposed to oral fluids.
The inflammatory reaction is soft tissues and potential
aller!ic response.
EBA and ot#er c#elate cements
In order to further impro"e on the basic *inc-oxide
,u!enol system. /any orkers ha"e in"esti!ated
mixtues of 5inc and other oxides ith other li'uid chelatin! a!ents.
;omposition and settin!? The *inc oxide contains +. to :.@
)luminium oxide or other mineral fillers; polymeric reinforcin! a!ents,
such as polymethyl methacrycate.
- The li'uid consists of -. to 6.@ ,#) ith the reminder
,u!enol.
In order to obtain optimal properties it is important to use as hi!h a
poder % li'uid ratio as possible i.e., :.-! per ml.
Properties:
The orkin! and settin! times ran!e beteen E and &- mts. The
film thickness is in the ran!e <.-E.mm.
;ompressi"e stren!th is -.-E. /pa.
Tensile stren!th is 6 to E /pa.
&+
/odulus of elasticity % - Gpa.
The ,#) cements sho "iscoelastic properties ith "ery
lo stren!th, and lar!e plastic deformation at slo 3..& mmH mint4 rates
of deformation and at mouth temperature 3:E;4. This says its retention
"alues for cron is lo than *inc phosphate cements.
7hen exposed to moisture, !reater oral dissolution occurs
than for other cements.
Adantages and %isadantages:
Advantages:
The principal ad"anta!es of the ,#) cements are their easy
mixin!.
Lon! orkin! time.
Good flo and lo irritation to the pulp.
Disadvantages:
- /ain is critical proportionin!.
- (ydrolic break don in oral fluids.
- Liability to plastic deformation.
- 9oorer retention than *inc phospate cement.
P'L.$ARB'/.LATE ( BA)E% $E!ENT)
,inc polycar0o-ylate cements: These cements ere de"eloped in late
&06.1s as an adhesi"e dental cement in the search for a material that ould
combine the stren!th properties of the phosphate system in the #iolo!ic
&:
acceptability of *inc oxide ,u!enol materials. These materials ha"e !one
throu!h se"eral sta!es of de"elopment since their acception and pro!ress is
continuin!.
$ompositon and c#emistry: The polycarboxylate cements are li'uid
systems.
The li'uid is an a'ueous solution of polyacrylic acid or a
copolymer of acrylic acid ith other unsaturated carboxylic acids, such
as itaconic acid.
The molecular net of the polyacids ran!es from :.,.. to
-.,.... The acid concentration may "ary to some de!ree from one
cement to another but usually is about <.@.
The composition and manufacturin! procedure for the
poder are similar to those of *inc phosphate cement. The poders
mainly 5inc oxide ith some /a!nesium oxide. 2tannic oxide may be
substituted for ma!nesium oxide. =ther oxides, such as bismuth and
)luminium, can be added. The poder may also contain small
'uantities of stannous flourides, hich modify settin! time and enhance
manipulati"e properties. It is an important additi"e because it increases
stren!th. (oe"er, the flouride released from this cement is only a
fraction 3&-@ to E.@4 of the amount released from 2ilicophosphate and
!lass ionomer cements.
The settin! reaction of this cement in"ol"es particle
surface dissolution by the acid that releases 5inc ma!nesium, and tin
ions, hich bind to the polymer chain "ia the carboxyl !roups, as !i"en
belo. These ions react ith carboxyl !roups, as ad$acent polyacid
&<
chains so that a cross-linked salt is formed as the cement sets. The
hardened cement consists of an amorphous !el matrix in hich
unreacted particles are disposed. The microstructure resembles that of
*inc phosphate cement in appearance.
)TRU$TURE '1 T&E $&E!I$AL
The role of carboxylate functional !roups in polycarboxylate cements?
) Iieldin! matrix throu!h cross linkin! by 5inc ions.
# #ondin! to tooth structure throu!h ;alcium hydroxide4.
- 7ater settable "ersions of this cement are a"ailable, the
polyacid is a free5e dried poder that is then mixed ith the cement
poder. The li'uid is ater or a eak solution of Na(
+
9=
<
. (oe"er,
the settin! reaction is the same hether the polyacid is free5e dried and
subse'uently mixed ith ater or if the con"entional a'ueous solution
of polyacid is used as the li'uid.
Bonding to toot# structure? The outstandin! characteristics of this cement
are that it bonds chemically to the tooth structure. The mechanism is not
clear but as shon in abo"e dia!rams, the polyacrylic acid is belie"ed to
react "ia the carboxyl !roups ith calcium of (ydroxyapitite. 3In reference
to GI;, the inor!anic component and the homo!eneity of enamel are
!reater than those of dentin. Thus, the bond stren!th to enamel is !reater
than that to dentin.
Properties? >or lutin! consistency the recommended poder to li'uid ratio
is &.- &3+tHt4. )bout the film thickness, the freshly mixed mix is in
spatulation and seatin! of a restoration, it exhibits shear thinkin!. Thus,
contrary to the sub$ecti"e impression that the correct mix for a *inc
&-
polycarbohydrate cement is much thicker than a lutin! 5inc phosphate mix.
Under presssure mix tends to thicken more 'uickly than the 5inc
polycarboxylate mix.
=ne of the most common errors made ith
polycarboxylate cements is to make a mix that appears to be a fluid as a
5inc phospate mix; this ill result in the use of lo poder-to-li'uid
ratio ith conse'uent poor properties in the cement. /easurin! de"ices
for these material ill ensure correct proportions.
The orkin! time is +.- to :.- minutes at room
temperature and the settin! time is 6 to 0 mts at :E;, the ater mix
materials tendin! to !i"e sli!htly lon!er settin! times. )s ith other
cements, orkin! time can be substantially increased by mixin! the
material on a cold slab and by refri!eratin! the poder. The li'uid
should not be chilled as this encoura!es !elation due to hydro!en
bondin!.
)t cement consistency the compressi"e stren!th from --
to C- /9a.
Tensile stren!th C to &+ /9a.
In !eneral these cements ha"e somehat loer compressi"e
stren!ths than 5inc phosphate cements but are si!nificantly stron!er in
tension. The cement !ains stren!th rapidly after the initial settin! period;
the stren!th at & hr. is about C.@ of the +< hr. "alue. These data indicate a
slo continuance of the settin! reaction tendin! toards !reater ri!idity
and more brittle beha"iour. (oe"er, the cement remains much less brittle
&6
and is tou!her than silicate, since phosphate, or !lass ionomer cement,
throu!h less so than a resin cement.
The solubility of the present day cements in distilled ater, hen
determined by a specification ei!ht loss method, ran!es from less than
..&@ to ..6@. The latter hi!h "alue relates particularly to cements that
contain stannous fluoride. ,ffecti"e fluoride release can be obtained
ithout substantial effects on the mechanical properties of the cement.
2i!nificant fluoride intake by nei!hbourin! enamel occurs. )s ith 5inc
phosphate cements, the solubility is much hi!her in or!anic acid solutions,
especially at loer 9( and if the acid has chelatin! poers.
>e recent clinical studies of solubility !a"e conflictin! results, to
studies conducted by /itchem and =sborne in &0EC respecti"ely shoin!
loer results than 5inc phosphate and the other the re"erse. #oth studies
a!reed in findin! the 5inc silicophosphate both the least loss of the cement
tested. In "i"o e"aluation of mar!inal leaka!e shoed similar results for
the to types of cement and hose results for an ,#) alumina cement.
Thus these all su!!ests that polycarboxylate cement has ade'uate clinic
performance.
The polycarboxylate cements display !ood adhesion to enamel, and
to a lesser extend, to dentin as ell as to the "arious alloys. )de'uate
fluidity of the mix and sufficient a"ailable carboxyl !roups are necessary
for interfacial interaction as ell as a surface free of contaminants and "oid
defects. #ondin! to both or alloy surface is reduced if contaminated ith
sali"a.
Biologic effects? The effect of *inc polycarboxylate cements on soft and
calcified tissues found to be moldin! /acrons in"esti!ators like 2mita
&E
8.;. in &0E&. The effect on the pulp is less than *inc oxide ,u!enol. The
!eneral biocompatibility of these materials seems excellent this appears to
be primarily due to the lo intrinsic toxicity the mild effect on the pulp and
other tissues is also due to the rapid rise of the 9( of the cement toards
neutrality; locali5ation of the polyacrylic acid and limitation diffusion try
its molecular si5e and acid ion bondin! to dentinal fluid ca and proteins;
and the minimal mo"ement of fluid in the dential tubules in response to the
cement the presence of stannous fluoride does not appear to affect the mild
respnse.
-It !i"es anticario!enic properties in fluorides containin! cements.
Adantages and %isadantages:
The main ad"anta!es of these materials are the lo irritancy
adhesion to tooth substance and alloys.
,asy manipulation and stren!th, solubility and film thickness
properties comparable to those of 5inc phosphate cements.
The need for accurate proportionin! for optimal properties and thus
more critical manipulation.
The loer compressi"e stren!th and !reater "iscoelasticity from
5inc phosphate cements, the short orkin! time of some materials and
the need for clean surfaces to utili5e the adhesion potential.
Remoal of e-cess cement
8urin! settin!, the polycarboxylate cement passes throu!h a
rubbery sta!e that makes the remo"al of the excess cement 'uite difficult.
&C
The excess cement that has extruded beyond the mar!ins of the castin!
should not be remo"ed hile the cement is in this sta!e, because there is
dan!er that some of the cement may be pulled out from beneath the
mar!ins, lea"in! a "oid. The excess should not be remo"ed until the
cement becomes hard. The outer surface of the prosthesis must be coated
carefully ith a separatin! medium such as petroleum $elly to pre"ent
excess cement from adherin!.
- ;are should be taken not to allo the medium to touch the
mar!in of the prosthesis. )nother approach is to start remo"in! excess
cement as soon as seatin! is completed. The !oal of these to method
is to a"oid remo"in! the excess durin! th rubbery sta!e.
GLA)) I'N'!ER $E!ENT:
Type I GI; is desi!ned for cementation of castin!s.
$ompositon and setting? These materials ere formulated by brin!in!
to!ether the silicate and poly acrylate system. =ri!inally the use of silicate
!lasses in the 5inc polycarboxylate cements as en"isa!ed that the
a"ailable material ere insufficiently reacti"e. 7ilson and Jent and their
coorkers in &0E- de"eloped !lasses that ere ion % leachable by a'ueous
polyacrylic acid and its acid copolymers. The poder in these materials is
a fine !round calcium aluminium fluoro-silicate !lass ith a particle si5ed
of around <. cm for the fillin! materials and less than +-cm for the lutin!
materials. The li'uid is a -.@ a'ueous solution of a polyacrylic % Itaconic
acid or other poly carboxylic acid copolymer containin! about -@ tartaric
acid. =n mixin! the acids react ith the !lass leachin! ca and aluminium
ions from the surface hich cross-link the polyacid molecules into a set. )
recent material has the polyacid contained in the poder and the li'uid is a
&0
solution of the tartaric acid. This contributes to easier mixin! and better
stability.
Properties: The poder to li'uid ratio for lutin! is about &?:?& for the
con"entional types of !lass ionomes cement. #est results on a chilled seas.
The slo ratio of hardenin! initially durin! formation of the calcium
polysalt before al cross linkin! becomes effecti"e means that the cement is
sensiti"e to moisture and more soluble durin! the early sta!es of its
hardenin!. The !el can also cra5e if alloed to dry out. Thus, it is essential
to protect exposed mar!ins until sufficient stren!th has de"eloped
The settin! time is C to 0 mts. somehat shorter than ith 5inc
phosphate cements.
The film thickness less than :. cm as also comparable and as
ade'uate to seat castin!s satisfactorily.
="er +< hours the compressi"e stren!th increased to 0.. to &<..
/pa.
Tensile stren!th to 6. to C. /pa.
- The modulus of elasticity as about E /pa.
) !lass ionomer cement shoed superior retention of !old inlays
and onlays compared ith a phosphate and a silicophospate cement.
- The solubility of the cements in ater as about &@ and this
as increased in artificial sali"a and lactic acid.
+.
Good resistance to dissolution as obser"ed under clinical
conditions. (oe"er, the initial slo set and moisture sensiti"ity may
contribute to leaka!e.
Farnish protection is desirable.
These cements ha"e potential for adhesion to enamel, dentin and
alloys in a similar manner to the polycarboxylate. In "itro the adhesion is
"ariable and affected by surface conditions. 2li!ht and "ariable mar!inal
leaka!e in tests of cemented restorations has been reported.
Biologic effects? ,"idence fro in "itro testin! and clinical experience ith
the restorati"e form of the !lass ionomer cements su!!est the tissue
response ould be similar to the 5inc polycarboxylate cements. (oe"er,
there is only limited data on the lutin! cements. 9aterson and 7atts
obser"ed pulp necrosis in rat molars after application to exposures.
(oe"er parma$er et. al. found little pulp irritation from one commercial
cement in ca"ities in monkey teeth after : months. Likeise Geisbick in
&0C., in a clinical study, found in sli!ht sensiti"ity on cementin! but no
e"idence of hypersensiti"ity after 6 months. (oe"er, some cases o
postoperati"e sensiti"ity ha"e been reported and this may be due to
mismanipulation and mar!inal leaka!e of bacteria.
Adantages and disadantages:
Advantages? The !lass ionomer cement materials include easy mixin!,
hi!h stren!th and stiffness, leachable fluoride, !ood resistance to acid
dissolution, and potential adhesi"e characteristics.
+&
Disadvantages? It includes initial slo settin! and moisture sensiti"ity,
"ariable adhesi"e characteristics, radiolucency, and possible pulp
sensiti"ity.
9recautions should be taken to protect the pulp hen cementin!
restorations ith !lass ionomer cements. The priolo!ic considerations take
precedence o"er other matters, such as the potential for adhesion that
ensures a stron! bond to tooth structure. The smear layer on the cut surface
of the ca"ity preparation should not be remo"ed but should be left intact to
act as a barrier to the penetration of the tubules by the acid component of
the cement. )ll deep areas of the preparation should be protected by a thin
layer of a hard settin! calcium hydroxide cement.
!et#acrylate 2Resin+ 0ased cements:
) "ariety of Gesin-based comments ha"e no become a"ailable
because of the de"elopment of the direct fillin! resin ith impro"ed
properties, the acid etch techni'ue for attachin! resins to enamel, and
molecules ith a potential to bond to dentin conditioned ith or!anic or
inor!anic acid.
Acrylic cements:
>or many years poder to li'uid cold curin! acrylic cements ha"e
been a"ailable. These materials ha"e been used for the cementation of
restorations, of temporary crons, and also as core materials. The poder
in these materials is a finely di"ided methyl-methacrylate polymer or
copolymer containin! ben5oyl peroxide as initiations. /ineral filler and
pi!ments may also be present. The li'uid is a methyl methacrylate
monomer containin! an amine accelerator. The material sits by
++
polymeri5ation of the monomer, hich concurrently dissol"es and softens
the polymer particles. The set mass consists of the ne polymer matrix
unitin! the undissol"ed but sollen ori!inal lar!er polymer beads or
particles.
These cements are stron!er and less soluble than other cements but
display lo ri!idity and "isco-elastic properties. They ha"e no effecti"e
bond to tooth structure in the presence of moisture and tins permit mar!inal
leaka!e althou!h they may sho better bondin! than other cements to resin
facin!s and polycarbonate crons. 9ulp reaction on "ital dentin from
monomer in the unset material, and residual monomer in the set material
are biolo!ic concerns. =ther problems include the short orkin! time and
the difficulty in remo"in! excess materials from mar!ins.
Bis3G!A type cements:
The materials of more recent de"elopment are based on the
#I2G/) system and thus are combinations of an aromatic dimethacrylate
ith other monomers. 2uch materials ha"e been supplied as to "iscous
li'uid or to pastes. The material that has been idest explanation and
in"esti!ation is a poder to li'uid combination.
The poder is a finely di"ided borosilicate !lass of a"era!e particle
si5e of &-mm. The particles are silam treated to impro"e bondin! and
contain an or!anic peroxide initiator. The li'uid is based on the reaction
product of the di!lycidyl either of bis-phenol ) and methacrylic acid.
7hich is diluted ith a lo "iscosity monomer such as ethylene !lycol
demethacrylate. )n amine )ccelerators is also present. =n mixin! the
polymeri5ation of the monomer mixture occurs, leadin! to a hi!hly cross
linked composite resin structure. The material is easily mixed to a fluid
+:
consistency and is used in con$unction ith an etchin! solution of -.@
citric acid to clean the tooth surface and promote adaptation and bondin!.
The mix rapidly increases in "iscosity and orkin! time is short.
7hen set, the material has hi!her bendin! and compressi"e
stren!ths than other cements. The modulus of elasticity as found to be
less than for 5inc phosphate, but the plastic strain at fracture and tou!hness
much hi!her. 2ections of cemented castin!, re"ealed spaces at the tooth
resin interfaces, presumably due to polymeri5ation contraction. )lthou!h
bondin! as impro"ed by citric acid treatment, it appeared to be
attributable to penetration of resin into the tubules, a phenomenon that has
also been obser"ed by Fon!iduklakis and 2mith.
)lthou!h the stren!th and resistance to dissolution of this type of
material is superior to any other type of cement, these biolo!ic and
practical 'uestions common to other types of resin cement ha"e limited its
use on "ital teeth. 9oorer retention for full crons than for other types of
cement as obser"ed by ;han et al in &0E-. These problems also include
short orkin! time, difficulty in seatin! castin!s and difficulty in remo"in!
excess material. They may be best suited to lon! term temporary
concentration of a loose fittin! castin! hen restoration care is delayed.
1actors affecting t#e clinical performance of cements:
The correct seatin! of a restoration is important to occlusal function,
esthetics and durability of the cement, especially in relation to securin! the
thinnest set cement time beteen restoration and tooth.
)nother factor that influence the material situation is the taper and
mar!inal !eometry of the restoration.
+<
$#aracteristics of a0utment ( Prost#esis interface:
7hen to relati"ely flat surfaces are brou!ht into contact,
)nalo!ous to a fixed prosthesis bein! placed on a prepared tooth, a space
exists beteen the substrates on a microscopic scale. )s shon is >i! &
typical prepared surfaces on a microscopic scale are rou!h that is there are
peats and "alleys. 7hen to surfaces are placed a!ainst each other, there
are only point contacts alon! the peaks 3>i!+4. The areas that are not in
contact then become open space. The space created is substantial in terms
of oral fluid flo and bacterial in"asion. =ne of the main purpose of a
cement is to fill this space completely. =n can seal the space by placin! a
soft material, such as an elastomer, beteen the to surfaces that can
conform under pressure to the Krou!hnessL. The current approach is to use
the technolo!y of adhesi"es. )dhesi"e bondin! in"ol"es the placement of a
third material, often called a cement, that flos ithin the rou!h surfaces
and set to a solid from ithin a fe minutes 3>i! :4. The solid matter not
only seals the space but also retains the prosthesis. If the third material is
not fluid enou!h or is incompatible ith the surfaces, "oids can de"elop
around deep, narro "alleys 3>i! <4 and undermine the effecti"eness of the
cement.
>i!ure & >i!ure +
>i!ure : >i!ure <
Procedure for cementation of prost#esis? to be effecti"e cement must be
fluid and be able to flo into continuous film of +-mm thick or less
+-
ithout fra!mentation. The procedure consists of placin! the cements on
the internal surface of the prosthesis and extendin! sli!htly o"er the
mar!in, seatin! it on the preparation, and remo"in! the excess cement at an
appropriate time. ;ementation of a sin!le cron as an example is described
ith 3>i! -a4.
Placement of cement? The cement paste should coat the entire inner
surface of the cron and extend sli!htly beyond the mar!in. It should fill
about half of the interior cron "olume 3>i! -b4. the clinician should make
certain that the occlusal aspect of the tooth preparation is free of "oids to
ensure that there is no air entrapment in the critical area durin! the early
a!e of the seatin!.
)eating? The important factors in seatin! the cemented restoration include
the rheolo!y of the cement, the orkin! time, the final film thickness and
the !eometry of the !ap throu!h hich the excess cement.
They may be suited to lon!term temporary cementation of a loose
fillin! castin! hen restoration care is delayed must escape. The cement
should ha"e a fluid consistency and alon! orkin! time. The mix should
also et tooth and restriction surface readily. In these respects, fluid
hydrophilic materials appear desirable. The flo or rheolo!ic
characteristics of the cement mix are a function of the pressure and !ap
si5e. The correct mixes of 5inc phosphate, polycarboxylate, and ,#)
cements flo on to lo film thickness ith moderate pressure under
practical conditions.
The data of (oard et al usin! a model full cron die system shoed
that the most fluid cement 35inc oxide eu!enol4 !enerated least hydraulic
+6
pressures duirn! seatin! folloed by polycarboxylate ith 5inc phosphate
exhibitin! !reatest peak and residual hydraulic pressure.
#oth ,ames and associates and (embree and ;oorkers ha"e
confirmed that "entin! is a satisfactory method of achie"in! minimal film
thickness under crons. In addition to "entin!, pro"ision of a :.mm relief
space or etchin! aay the interior of the castin! ha"e been su!!ested.
,ames et al found better seatin! of full crons usin! &. and +.A
con"er!ence an!les and recommended the most satisfactory techni'ue for
alloin! escape of cement to be a die relief method.
/oderate fin!er pressure should be used to displace excess cement
and to seat the cron or other prosthesis on the preparation. )n
alternati"ely method is to use a "ibrational instrument to facilitate the
seatin! of the prosthesis ithout creatin! excess pressure. )fter the
mar!inal !ap area is e"aluated for closure ith an explorer the patient may
be asked to complete the seatin! by bitin! on a soft piece of ood hich is
static method and a round stick rollin! on the cron hich is called as
dynamic method. 8urin! this sta!e, the last increment of excess cement is
expelled throu!h the space beteen the prosthesis and the tooth. )s the
prosthesis reaches its final position on the preparation. The space for
expellin! the excess cement becomes smaller, makin! the seatin! more
difficult 3>i! -c4. "ariable that can facilitate scalin! include usin! a cement
of loer "iscosity, increasin! the taper and decreasin! the hei!ht of the
cron preparation 3>i! -d4 "ibration, and introducin! escape "ents on the
occlusal aspect of the prosthesis 3>i! -e4, increasin! the de!ree of taper can
compromise retention, monomer the escape "ents can be filled ith !old
foil or cast !old plu!s. If the occlusal surface contacts the axial all of the
tooth durin! insertion, air pockets may be introduced 3>i! -f4.
+E
Remoal of E-cess cement:
The excess cement aluminates around the mar!inal area at the
completion of seatin!. Its remo"al depends on the properties of the cement
used. If the cement sets to a brittle state and does not adhere to the
surroundin! surfaces, the tooth and the prosthesis, it is best remo"ed after it
sets. This applies to 5inc phosphate, silicophasphate, and *o, cements. >or
!lass ionomer cements, polycarboxylate cements and resin based cements
that are potentially capable of adherin! both chemically and physically to
the surroundin! surfaces the protocol of excess cement remo"al "aries.
=ne can coat the surroundin! surface ith a separatin! medium such as
petroleum $elly, thereby inhibitin! the materials adherence to the surfaces,
and remo"e the excess after the cement sets. )nother techni'ue in"ol"es
the remo"al of excess cement as soon as the seatin! is completed, thus
pre"entin! the material from adherin! to the ad$acent surfaces.
Post cementation
)'ueous based cements continue to nature o"er time ell after they
ha"e passed the defined settin! time. If they are alloed to nature is an
isolated en"ironment, that is free of contamination from surroundin!
moisture and free from loss of ater throu!h e"aporation, the cements ill
ac'uire additional stren!th and become more resistance to dissolution. It is
recommended that coats of "arnish or a bondin! a!ent should be placed
around the mar!in before the patient is dischar!ed.
!ec#anism of retention:
) prosthesis can be retained by mechanical or chemical means or a
combination of mechanical 6 mechanical factors.
+C
)s e kno the retention of crons, brid!es is a function not only
of the mechanical properties of the lutin! a!ent but also the desi!n of the
tooth preparation and the restoration. There factors influence the stress
distribution ithin the interposed cement layer, the efficiency of bondin!
of the cement to both of the surfaces bein! $oined, and the durability of the
cement that include its lon!-term resistance to mechanical breakdon and
dissolution.
)nalysis of the stress distribution in the restored tooth indicate that
compressi"e shear and tensile forces are all !enerated in the cement layer.
;rai! and >arah recommended that a cement ith a hi!h tensile
stren!th should be used for the cementation of crons as shear stresses in
the mar!inal area can exceed the stren!th of lo stren!th cements. >or the
support of restorations, the tensile stren!th as a!ain found to be
important, but the most important property as the elastic modulus of the
cements 3stiffness4. )s pre"iously noted, except for the resin cements, 5inc
polycarboxylates tend to display the !reatest tensile stren!th, but ha"e
loer modulus and compressi"e stren!th than 5inc phosphate cements. The
silicophosphate and !lass ionomer cements tend to be superior in the latter
property to both these cements, but are better materials of loer tensile
stren!th, the ,#) and resistance to plastic deformation.
Theoretically, chemical bonds can be resist interfacial separation
and thus impro"e retention. )'ueous cement based on polyacrylic acids to
pro"ide chemical bondin! throu!h the use of acrylic acids. Gesin based
cements usin! some specialty functional !roups also ha"e exhibited
chemical bondin!. ;a"ity "arnish reduces retention for all cements.
Impro"ed mechanical and adhesi"es retention is obtained for all cements
+0
by careful clearin! of the preparation to remo"e residual temporary cement
and all residues includin! cuttin! debris. 2uch cleansin! may include
mechanical treatment 3premier slurry4 and chemical a!ents such as
deter!ent cleaners and ,8T). 2uch a!ents ha"e yet to be fully optimi5ed,
hoe"er, similarly the interior of restorations should be cleansed by sand
blastin! or etchin!.
%islodgement of prost#esis? >ixed prostheses can debond because of
biolo!ic or physical reasons or a combination of the to. Gecurrent caries
results from a biolo!ic ori!in. 8isinte!ration of the cements can result from
fracture or erosion of the cement. >or brittle prostheses, such as !lass
ceramic crons, fracture of the prosthesis also occurs because of physical
factors, includin! intraoral forces, flas ithin the cron surfaces, and
"oids ith in the cement layer.
In the oral en"ironment cementation a!ents are immersed in an
a'ueous solution. In this en"ironment the cement layer near the mar!in can
dissol"e and erode lea"in! a space 3>i! E4. This space can be susceptible to
pla'ue accumulation and recurrent caries; therefore, the mar!in should be
protected ith a coatin! 3if possible4 to allo continues settin! of the
cement. There are to basic modes of failure associated ith cements.
;ohesi"e fracture of the cement 3>i! Ca4 and separation alon! the interface
3>i! C b4. because the cement layer is the eakest link of the entire
assembly, one should fa"or hi!her stren!th cements to enhance retention
and pre"ent prosthesis dislod!ement by pro"idin! a firm support base
a!ainst applied forces.
To summuries the factors of retention of fixed prosthesis.
:.
&. The film thickness beneath the prosthesis
should be be thin. It is belie"ed that a thinner film has feer internal
flos compared ith a thicken one.
+. The cement should ha"e hi!h stren!th "alues.
:. The dimensional chan!es occurrin! in the
cement durin! settin! should be minimi5ed, hence isolate the cement
immediately after remo"al of the excess.
<. ) cement ith the potential of chemically
bondin! to the tooth and prosthetic surfaces or bond enhancin!
intermediate layers may be used to reduce the potential of separation at
the interface and maximi5e the effect of the inherent stren!th on the
retention.
7hen a mechanical undercut is the mechanism of retention, the
further often occurs alon! the interfaces. If chemical bondin! is in"ol"ed,
the failure often occurs cohesi"ely throu!h the cement itself. The
prosthesis become loose only hen the cement fracturer or dissol"es.
>i!? >ailure modes of the interface, )4 ;leara!e throu!h the cement
layer. This is unlikely because of the dimension of the cement in"ol"ed. #4
The most likely failure that occurs at the cement prosthesis and cement
tooth interfaces. Gemnants of the cement often remain on the opposin!
surfaces.
:&
)ummary
It is e"ident that none of the materials a"ailable to use at present is
free from deficiencies in the re'uired clinical characteristics such as
biocompatibility, ease of manipulation, satisfactory sealin! and retenti"e
properties, and lon! term stability. Thus, a proportion of clinical failure is
ine"itable. This incidence can minimi5ed by proper selection and
manipulation of the cement as pre"iously outlined, hoe"er, the to
principal modes of failure for the cement lute 3namely, dissolution,
includin! erosion and disinte!ration, and mechanical breakdon4 are both
dependent on the clinical situation as ell as on the intrinsic properties of
the cement. >actors ithin the control of the clinician, such as the desin! of
the preparation, the fit of the restoration the manipulation of the cement,
the seatin! of the restoration and the finishin! of the mar!ins are some of
the important determinants of success.
) more rational approach to cement selection manipulation and
cementation procedures can !i"e us impro"ed postoperati"e results and
!reater a"era!e lon!e"ity of the restoration. (oe"er the de"elopment of
ne and impro"ed cement systems ith hi!her stren!th and stiffness and
loer oral dissolution is re'uired. )dhesi"e and anticario!enic properties
are also desirable. /ore research is needed on cement performance in
clinical practice for both simple and complex restorati"e procedure to
de"elop a predicture correlation beteen laboratory measurements and
clinical performance. Impro"ed laboratory and clinical characteri5ation of
cements should lead us to the !oal of an adhesi"e biocompatible cement
that ill last as lon! as the restoration.
:+
$'NTENT)
&. Introduction
+. #asic ;onsideration
:. Types of cement
<. >actors affectin! the clinical performance of cements
a. ;haracteristics of abutment prosthesis interface
b. 9rocedure for concentration of prosthesis
c. 9lacement of cement
d. 2eatin!
e. Gemo"al of excess cement
f. 9ost cementation
!. /echanism of retention
h. 8islod!ement of prosthesis
-. 2ummary
::