Dental Cements

Dental cements can be categorized by their main components into five

main groups: zinc phosphate, zinc polycarboxylate, glass ionomer, resin-
modified glass ionomers, and resin cements (Table).

Zinc Phosphate

Known as one of the very first permanent cements to emerge onto the
dental market, zinc phosphate is the standard against which contemporary
cements are assessed. The many uses of this cement include permanent
cementation of crowns, orthodontic appliances, intraoral splints, inlays,
post systems, and fixed partial dentures.2 Of the various manufacturers of
zinc phosphate, the most commonly used brands include DeTrey Zinc
Improved (DENTSPLY Caulk, www.caulk.com), Fleck’s Zinc (Mizzy,
Pearson Lab, Pearson dental.com), Hy-Bond® (Shofu Dental Corporation,
www.shofu.com), and Modern Tenacin (DENTSPLY Caulk).3 Zinc
phosphate exhibits high compressive strength, moderate tensile strength,
and clinically acceptable thin film thickness when applied properly
according to the manufacturer’s instructions. The major disadvantages are
its initial low pH, which has been reported to contribute to pulpal irritation,
and its inability to bond chemically to tooth structure.4 Despite its
disadvantages, this dental material has proven to have a significant
amount of clinical success associated with its long-term use.1

Zinc Polycarboxylate

Invented in 1968, zinc polycarboxylate cement was the first cement to

exhibit a chemical bond to tooth structure.1 Very little pulpal irritation is
seen with its use due to the large size of the polyacrylic acid molecule.4
The many uses of this cement include permanent cementation of crowns,
bridges, inlays, onlays, and orthodontic appliances.5 Polycarboxylate will
bond to most alloys such as stainless steel, but not to gold.4 Of the various
manufacturers of zinc polycarboxylate, some commonly used brands
include Durelon™ (3M ESPE, www.3mespe.com), Shofu Polycarboxylate
(Shofu), and Tylok® Plus/Poly-F-Plus (DENTSPLY Caulk).6 An
encapsulated version of Durelon, Durelon™ Maxicap™ (3M ESPE),
tackles the challenges of a short working time and an excessive film
thickness displayed by this cement.6 Although zinc polycarboxylate has the
advantage of producing a moderately high bond to enamel and dentin, its
use has lessened over the years.4

Glass Ionomer

It was not until 1977 that glass-ionomer cements became available in the
United States, after being introduced to the world in 1972 by Wilson and
Kent.7 Its chemical make-up typically consists of a fluoroaluminosilicate
glass powder and polyacrylic acid liquid. The many uses of this cement
primarily include permanent cementation of crowns, bridges, inlays,
onlays, posts, and orthodontic appliances. “Glass ionomer cements can
chemically bond to stainless steel, base metals, and tin-plated noble
metals, but not to pure noble metals or to glazed porcelain.”7 Of the various
manufacturers of traditional glass-ionomer cements, some commonly used
brands include non-encapsulated forms of Ketac™-Cem (3M ESPE),
Glass Ionomer Type 1 (Shofu), the old and new versions of Fuji Ionomer
Type 1 (GC America, www.gcamerica.com), the encapsulated products of
Fuji I® (GC America), and Ketac™-Cem Aplicap™ (3M ESPE).7 In order to
achieve clinical success with glass-ionomer cements, early protection from
both moisture contamination and desiccation is necessary. The initial low
pH that glass ionomers exhibit contributes to postoperative sensitivity.
However, the advantages of chemically bonding to tooth structure, its
bacteriostatic effect, fluoride release, and adequate compressive and
tensile strength make this an acceptable cement.4 Glass-ionomer cements
are still used today, but their use has seen a slight decline because they
yield retention rates comparable to zinc phosphate.1

Resin-Modified Glass Ionomers

Around the early 1990s, advancements with glass-ionomer cements

involved supplementing part of the polyacrylic acid in traditional glass-
ionomer cements with hydrophilic methacrylate monomers, resulting in
resin-modified glass-ionomer cements.1 The many uses of this cement
primarily include permanent cementation of crowns, bridges, inlays,
onlays, posts, and orthodontic appliances. Resin-modified glass-ionomer
cements typically are indicated for use with the following dental materials:
metallic and PFM restorations, zirconia and alumina-based ceramics, and
lithium-disillicate pressed and milled (CAD/CAM) inlays and onlays.8 All-
ceramic crowns such as IPS Empress® (Ivoclar Vivadent,
www.ivoclarvivadent.com) or VITA In-Ceram® (Vident™, http://vident.com)
should not be cemented with these cements because of potential clinical
fractures.3 Of the various manufacturers of resin-modified glass-ionomer
cements, some commonly used brands include FujiCEM™ and Fuji PLUS
(GC America), RelyX™ Plus Luting Cement (3M ESPE), and Riva Luting
Plus (SDI Limited, www.sdi.com). In addition to the chief advantages seen
with traditional glass ionomers, resin-modified glass-ionomer cements
have shown improvements in postoperative thermal sensitivity and are
insoluble in the oral cavity.8 Yet, adequate retention is not exhibited on
preparations with poor retention and resistance from using resin-modified
glass-ionomer cements.1

Resin Cements

Resin cement contains dimethacrylates, such as bisphenol A-glycidyl

methacrylate (Bis GMA), urethane dimethacrylate (UDMA), and
tetraethyleneglycol dimethacrylate (TEGDMA), or, which can polymerize in
variable ratios to achieve the desired viscosity. The dimethacrylate allows
polymerization of the resin cement into a dense cross-linked polymer,
which is similar in consistency to flowable composite.9

As a result of the polymerization process, resin cements are highly

resistant to moisture and, therefore, become highly durable cements.11 The
many advantages of resin cements are shade selection, translucency,
greater retention by the bonding process, low film thickness, and adhesion
that occurs between the tooth preparation and the ceramic in direct
restorations.4 The adhesion process is facilitated by resin cement and can
be polymerized by light, chemicals, or a dual process.10 According to the
clinical circumstances, a clinician has a choice of using three different resin
cements, which include: light-cured, dual-cured, and self-cured.11
Light-Cured Resin Cements—Light-cured cements are indicated when the
ceramic restoration has a thin thickness, and is positioned in an easily
accessible part of the mouth, allowing moisture control. These cements are
well suited for bonding ceramic inlays and onlays and veneers. Examples
of these cements include: Variolink® Veneer (Ivoclar Vivadent), RelyX™
Veneer Cement (3M ESPE), Calibra® (DENTSPLY Caulk) and CHOICE™
2 Veneer Cement (BISCO Dental Products, www.bisco.com)15 Most of
these manufacturers provide numerous shade selections for these
cements, which makes them ideal for esthetic restorations.13
Dual-Cured Resin Cements—Dual-cured cements are most suitable for
when the ceramic restoration is too thick or too opaque for light
penetration, or the restoration is not easily accessible to light. Examples
include NX3 Nexus® Third Generation (Kerr Dental Corporation,
www.kerrdental.com), RelyX™ ARC Adhesive Resin Cement (3M ESPE),
Multilink® Automix (Ivoclar Vivadent), DUO-LINK™ (BISCO), RelyX™
Unicem Self-Adhesive Universal Cement (3M ESPE), SpeedCEM® (Ivoclar
Vivadent), and Maxcem Elite™ (Kerr).9 The dual-cured cements are
extremely technique-sensitive and benefit from using the light
polymerization.
Auto-Cured Resin Cements—Self-cured or auto-cured cements do not
require the light for polymerization; they are cured by a chemical reaction.
They are best suited for cementing metal or opaque ceramics like
NobleProcera™ Alumina (Noble Biocare, www.noblebiocare.com), and
VITA In-Ceram® Alumina (Vident). The advantages of these cements are
ease of use and simplification, saving valuable chairtime for the
practitioner. Unfortunately, clinical results and in vitro studies have shown
these cements to have lower bond strength than light-cured or dual-cured
cements.12,13 Examples of these cements include Panavia™ F2.0 (Kuraray
Dental, www.kuraraydental.com) and C&B Metabond® (Parkell, Inc.,
www.parkell.com).9 The manufacturers of these cements only offer a few
varieties of shade selection and translucency.

Adhesive Systems
Clinicians are also faced with decision-making regarding the adhesive
system, which allows the cement to adhere to the tooth structure. The two
main categories of resin cement’s mechanism of adhesion are as follows:
total-etch bonding agent and self-etching bonding system.10

Total-Etch Bonding Agent

The total-etch bonding system involves using phosphoric acid on enamel

and applying hydrofluoric acid (silane) treatment to the inside surface of
the ceramic veneer or onlay before the restoration is bonded. This
technique allows maximum adhesion to enamel; however, it may cause
postoperative sensitivity. It is best suited for veneers and translucent inlays
and onlays, allowing the operator to modify and enhance the shade.12,13

Self-Etching Bonding System

Most clinicians prefer this system for its simplified technique, which
combines the etch and adhesive steps, followed by the application of
cement.14 Postoperative sensitivity seems to be significantly reduced by
sealing the dentinal canals and providing bond to dentin and enamel.13

Bond strength may be lower and adhesion to enamel may be the

drawbacks of the self-etching bonding system.15 Tooth-colored inlays and
onlays, and moderate-strength all-ceramic crowns are the most
appropriate restorations for the self-etch bonding system.12

Conclusion
The prevalence and demand of all ceramic restorations has increased in
the past decade to meet the esthetic demands of patients. As a result,
resin cements have become more prevalent in cementation of tooth-
colored restorations. Given that a universal cement is not yet available, it is
the responsibility of the clinician to assess the tooth preparation and the
characteristics of the indirect restoration in order to make the best
selection of cement.