LUTING AGENTS FOR FIXED PROSTHODONTICS

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;
provisional or interim restorations; laminate veneers for anterior teeth;
orthodontic appliances; and pins and posts used for retention of
restorations. The long-term clinical outcome of fixed prosthodontic
treatment depends, in part, on the use of adhesives that can provide an
impervious seal between the restoration and the tooth. Schwartz et al in
!"# found that loss of crown retention was the second leading cause of
failure of traditional crowns and fixed partial dentures. Therefore the
clinical success of these luting agents depends on the cementation
procedure and clinical handling of these materials.
The word $luting% is often used to describe the use of a moldable
substance to seal a space or to cement two components together.
There are several types of available luting agents, each possessing
uni&ue properties and handling characteristics. No one product is ideal for
every type of restoration; some of them re&uiring multiple techni&ue
sensitive steps. 'lthough the establishment of optimal resistance and
retention forms are obtained from proper tooth preparation, luting agents
should essentially serve the following purposes(
a) 'ct as a barrier against microbial and the restoration.
b) Seal the interface between the tooth and the restoration.

c) *old the restoration and tooth together through some form of

surface attachment.
This attachment may be mechanical, chemical or a combination of both
methods.
+deal re&uirements of luting agents(
i) Should provide a durable bond between dissimilar materials.
ii) Should possess favourable compressive and tensile strengths.
iii) Should have sufficient fracture toughness to prevent
dislodgement as a result of interfacial or cohesive failures.
iv) Should be able to wet the tooth and the restoration.
v) Should exhibit ade&uate film thic,ness and viscosity to ensure
complete sealing.
vi) Should be resistant to disintegration in the oral cavity.
vii) Should be tissue compatible.
viii) Should demonstrate ade&uate wor,ing and setting times.
-resently there are cements used for the temporary or permanent
cementation of fixed prosthesis. They are(
) .inc phosphate.
/) .inc oxide-eugenol.
0) .inc oxide-non-eugenol.
1) .inc polycarboxylate.
2) 3lass ionomer Type +.
4) 5esin composite cements or compomers.
") 5esin-modified glass ionomer or hybrid ionomers.
/
1) Zinc phoph!t" c"#"nt
'6' specification No. 7 in !02 defines the properties and
re&uirements for zinc phosphate cement.
Po$d"r %"i&ht '()
.inc oxide 8.n9) principal ingredient. !#./
:agnesium oxide 8:g9) reduces the
temperature of the calcination process.
7./
Silicon dioxide 8Si9
/
) inactive filler and aids in
the calcination process
.1
;ismuth trioxide 8;i
/
9
0
) imparts a smoothness
to the freshly mixed cement in large amounts it
may also lengthen the setting time.
#.
;arium oxide 8;a9), ;arium sulphate
8;a
/
S9
1
)
<alcium oxide 8<a9)
#.
Tannin-fluoride may be added in some commercial products.
The ingredients of the powder are heated and sintered at
temperatures between ###=< and 1##=< into a calcined mass, that is
subse&uently pulverized to a fine powder which is sieved to recover
selected particle sizes.
0
Li)uid %"i&ht '()
-hosphoric acid 8*
0
-9
1
) 8free acid) 07./
-hosphoric acid combined with aluminium and
zinc 'l and .n partially neutralize the acid,
temper its reactivity and act as buffering agents
which helps in establishing a smooth,
nongranular, wor,able cement mass.
4./
'luminium 8'l) /.2
.inc 8.n) ".
>ater *
/
9 04.#
Contro* th" "ttin& ti#" !nd #"ch!nic!* prop"rti"
The water content controls the ionization of the acid and influences
the rate of setting reaction. This is important to the clinician because an
uncapped li&uid bottle will permit loss of water resulting in retarded set.
S"ttin& r"!ction
>hen powder particles are wet by the li&uid, phosphoric acid
attac,s the surface of the particles and releases zinc ions into the li&uid.
The resultant mass yields a hydrated, amorphous networ, of zinc
aluminophosphate gel on the surface of the remaining portion of the
particle. The set cement is a cored structure consisting primarily of
unreacted zinc oxide particles embedded in a cohesive amorphous matrix
of zincaluminophosphate. +n presence of excess moisture formation of
crystalline hopeite 8.n
0
8-9
1
)
/
1*
/
9) ta,es place.
1
+!nipu*!tion
a) No definite -?@ ratio and maximum amount of powder should be
incorporated into the li&uid.
b) ' cool mixing slab should be employed. The cool slab prolongs the
wor,ing and setting times.
c) The li&uid should not be dispensed until the mixing is to be initiated
to prevent loss of water.
d) :ixing is initiated by incorporation of small portions of powder into
the li&uid over a wide area to minimize the heat and effectively
dissipate it.
e) Spatulate each increment for 2 seconds before adding another
increment.
f) <ompletion of the mix usually re&uires approximately minute 0#
seconds.
g) The casting must be seated immediately with a vibratory action
before matrix formation occurs.
h) 'fter the casting has been seated, it should be held under pressure
until the cement sets to minimize air inclusion.
i) The procedure should be carried out in a dry, clean environment.
A) Bxcessive cement should be removed after it has set and a layer of
varnish should be applied to the margin to decrease the initial
dissolution.
,) Crozen 3lass slab :ethod
+n this method a glass slab cooled at 4=< or at D#=< is used.
'round 2#E to "2E more amount of powder can be incorporated into the
2
li&uid. The wor,ing and setting times are prolonged with little difference in
physical and mechanical properties.
Prop"rti"
%or,in& !nd "ttin& ti#"
>or,ing time is the time from the start of mixing during which the
viscosity of the mix is low enough to flow readily under pressure to form a
thin film.
Setting time mean that matrix formation has reached a point where
external physical disturbance will not cause permanent dimensional
changes. +t is defined as the elapsed time from the start of mixing no longer
penetrates the cement as the needle is lowered onto the surface.
Net setting time is /.2 to 7.# minutes at 0"=< and ##E humidity it
varies from 2-! minutes.
F!ctor in-*u"ncin& th" "ttin& ti#".
Those controlled by manufacturer(
- -owder composition.
- 6egree of powder calcinations.
- -article size.
- ;uffering of li&uid.
- >ater content of li&uid.
4
Tho" contro**"d /0 th" op"r!tor !nd th"ir in-*u"nc" on "*"ct"d
prop"rti".
+!nipu*!ti1"
1!ri!/*"
Co#pr"i1"
tr"n&th
Fi*#
thic,n"

So*u/i*it0
Initi!*
!cidit0
S"ttin&
ti#"
6ecreased
-?@ ratio
6ecrease 6ecrease +ncrease +ncrease @engthen
+ncreased rate
of powder
incorporation
6ecrease +ncrease +ncrease +ncrease Shorten
+ncreased
mixing
temperature
6ecrease +ncrease +ncrease +ncrease Shorten
>ater
contamination
6ecrease +ncrease +ncrease +ncrease Shorten
Ph0ic!* prop"rti"
>hen properly manipulated, the set cement exhibits a compressive
strength of #1:-a, diametral tensile strength of 2.2:-a, modulus of
elasticity of 03-a. Thus it is &uite stiff and resistant to elastic deformation
even when it is used for cementation of restorations in high stress-bearing
areas. The strength is influenced by -?@ ratio, composition, manner of
mixing and handling of the cement.
So*u/i*it0 !nd diint"&r!tion
The solubility in water in /1 hours is #./E. Solubility depends on
initial exposure to water of the incompletely set cement resulting in
increased dissolution. 3reater resistance to solubility can be obtained by
increasing the -?@ ratio.
"
Conit"nc0 !nd -i*# thic,n"
Two consistencies are used i.e. luting and base. The luting
consistency is tenacious and provides a mechanical interloc,ing between
the surface irregularities of the tooth and the restoration. The maximum
film thic,ness is /!Fm. +t depends on the consistency and seating pressure.
2icoit0
Giscosity increases with increased -?@ ratio, mixing time and higher
temperature. +ncreased viscosity can result in increased film thic,ness and
incomplete seating.
Di#"nion!* t!/i*it0
+t exhibits shrin,age on hardening ranging from #.#1E to #.#4E in
" days.
Th"r#!* !nd E*"ctric!* conducti1it0
+t is an effective thermal insulator and protects against thermal
trauma to the pulp.
Acidit0
The acidity of the cement is &uite high at the time of cementation of
a prosthesis. Two minutes after the start of mixing the p* is approximately
/. +t increases rapidly but still is only about 2.2 at /1 hours.
The p* remains relatively low for long durations.
.inc phosphate cement does not chemically bond to tooth structure
and provides a retentive seal by mechanical means only. Thus, the taper,
length and surface area of the tooth preparation are critical to its success.
7
:icrolea,age, aggravated by dehydration in oral fluids and an initial low
setting p* may affect its biocompatibility in clinical use.
App*ic!tion
-ermanent luting of well-fitting, prefabricated and cast posts, metal
inlays, onlays, crowns, C-6s, and aluminous all-ceramic crowns to tooth
structure, amalgam, composite, or glass ionomer core build ups.
3) Zinc4o5id" Eu&"no* !nd 6) Non4"u&"no* c"#"nt
<omposition of Type + luting agent
Po$d"r %"i&ht '()
.inc oxide 4!.#
>hite resin reduced brittleness of the set cement /!.0
.inc state plasticizer .#
.inc acetate improves strength #."
@i&uid
Bugenol 72.#
9live oil 2.#
To increase the strength of the cement for luting purposes, two
modifications have been made Type ++ luting agents(
a) :ethyl methacrylate polymer is added to powder 8/#E by weight)
8Halzinol).
b) 'lumina 8'l/90) 80#E by weight) is added to powder and
ethoxybenzoic acid 8B;') is added to li&uids 84/.2E ortho B;' by
weight).
!
The non-eugenol cements contain an aromatic oil and zinc oxide.
9ther ingredients may include olive oil, petroleum Aelly, oleic acid, and
beeswax.
S"ttin& r"!ction
The cement sets by chelation reaction to form eugenolate and water.
The presence of moisture is essential for setting to occur.
+!nipu*!tion
' paper mixing pad is used. ' -?@ ratio of 1-4( is employed. The
bul, of the powder is incorporated in the initial step, the mix is thoroughly
spatulated, and then a series of smaller amounts is added until the mix is
complete.
:ixing time re&uired is usually !# seconds. The reinforced cements
are ,neaded for 0# seconds and then stopped for 4# seconds to develop a
creamy consistency.
Prop"rti"
Setting time ranges from 1 to # minutes. Cor reinforced cements,
since the -?@ ratio increases, the setting time decreases.
Setting time depends on composition of powder, particle size, -?@
ratio, accelerator and temperature.
Ph0ic!* prop"rti"
Type + luting cement has a compressive strength of /.#-1:-a, non-
eugenol cements have values of /."-1.7:-a, polymer modified has a
strength of 0":-a with B;'-alumina having the highest strength 41:-a.
Blastic modulus ranges from #.// for Type +, /." for Halzinol and 2.1
for B;'-alumina.
#
So*u/i*it0 !nd diint"&r!tion
6ue to the bleaching of eugenol, solubility is high and ranges
between .2 to /.2E. addition of additives decreases the solubility. The
solubility in water 8E) in /1 hours for polymer modified cements is #.#7
and B;'-alumina is #.#/-#.#1.
Fi*# thic,n"
Cilm thic,ness of polymer modified cement is /.2Fm and B;'
alumina is /2-02Fm.
Di#"nion!* t!/i*it0
Shows a shrin,age of #.!-/.2E on setting.
7io*o&ic prop"rti"
+t has a p* of "-7.
+t does not cause any harm to the pulp but due to leaching of
eugenol, it is an irritant. Therefore non-eugenol cements are used for some
patients.
*ighly compatible with the pulp and has an obtundant effect.
+t also has an antibacterial action.
+ts disadvantages such as decreased strength, high solubility, irritant
to soft tissues, poor retention and difficulty in manipulation limit its use for
temporary cementation purposes.
+t should not be used for temporary luting purposes when the
permanent luting agent is li,ely to be a resin cement as the eugenol inhibits
polymerization.

App*ic!tion
+t is used primarily for temporary luting of restorations.
0) Sdadsds
8) Zinc po*0c!r/o50*!t" c"#"nt 'Zinc po*0c!r/o50*!t" c"#"nt)
Co#poition
Po$d"r %"i&ht '()
.inc oxide 72
:agnesium oxide or stannic oxide #
Stannous fluoride traces of silica dioxide,
bismuth, aluminium and colour pigments.
1-2
The powder is sintered and fused to reduce the reactivity of zinc
oxide.
Li)uid
'&ueous solution of polyacrylic acid or copolymers of acrylic acid
in the range of 0#-1#E.
:olecular weight of /2,### to 2#,###.
Tannic acid and malleic acid #-12E.
Tartaric acid prevents gelation on storage 2E.
>ater settable cements D *ere the mixing li&uid is water D polyacrylic acid
is frozen, dried, powdered and mixed with the original -?@ ratio of these
cements is very high.
/
S"ttin& r"!ction !nd !dh"ion to tooth tructur".
>hen powder and li&uid are mixed, a fast acid-base reaction occurs
as the powders are rapidly incorporated into a viscous solution of high
molecular weight polyacrylic acid. The powder particles are attac,ed by
the acid and zinc, magnesium and tin ions are released. .inc ions react with
the carboxyl group of polyacrylic acid of the same chain and the adAacent
chain to cause cross lin,ing. The calcium ions of the tooth structure react
with the free carboxyl groups of acid to form a metallic ionic bond.
The bond between cement and dentin is 0.1 :-a. Inder ideal
conditions the adhesion of polycarboxylate cement to a clean, dry surface
of the tooth is greater than any other cement. The cement adheres better to
a smooth surface than to a rough one. +t does not adhere well to gold and
porcelain. The failure is at the cement-metal interface. <ement cannot bond
to the metal in chemically dirty or pic,led condition. Surfaces of the metal
have to be sandblasted or electrolytically etched to achieve optimum
bonding. 'dhesion with stainless steel is excellent.
0
+!nipu*!tion
-?@ ration is 2(.
' glass slate is used for mixing to prevent absorption of li&uid.
Cirstly a meticulously clean surface is essential to intimate contact and
interaction between the cement and the tooth. #E polyacrylic acid
solution is used to clean the tooth surface for #-2 seconds followed by
rinsing with water for removal of smear layer. 'fter cleansing, isolate the
tooth to prevent further contamination by oral fluids. ;lot the surface
before cementation.
The powder is rapidly incorporated into the li&uid in large &uantities
for a period of 0# to 4# seconds. :ixing on a cooled glass slab prolongs
the wor,ing time. The cement must be placed on the inner surface of
casting and on tooth surface before it loses its glossy appearance. @oss of
gloss indicates decreased availability of carboxyl groups, poor bonding,
poor wettability due to stringiness and increased film thic,ness causing
incomplete seating of the casting.
Pr"c!ution
6o not refrigerate the li&uid dispense the li&uid Aust before mixing.
:ixing should be rapid.
Ise only on cleaned surfaces.
Ise before glossiness disappears.
5emoval of excess cement
6uring setting, the cement passes through a rubbery stage. 6uring
this stage, excess cement should not be pulled away from the margins as it
can leave voids at the interface. 5emove excess cement only after it
1
becomes hard. 'pply petroleum Aelly to the outer surfaces of the prosthesis
and soft tissues to prevent cement from adhering to them.
Prop"rti"
Setting time is 4-! minutes.
>or,ing time /.2 D 0.2 minutes.
2icoit0
The set mix is pseudoplastic in nature. The cement seems viscous,
but during cementation pressure, excess flows out from under the margins
of the restoration.
Ph0ic!* !nd +"ch!nic!* prop"rti"
The compressive strength of /1 hour set cement is 2"-!! :-a;
tensile strength is 0.4-4.0:-a and elastic modulus is 1.#-1."3-a. ;ond
strength to dentin is /.:-a, to enamel is 0.1-0:-a.
Cilm thic,ness of polyacrylate cements is /2-17 Fm.
Solubility of cement in water is low 8J#.#2E) but when it is
exposed to organic acids with a p* of 1.2 or less, the solubility increases
mar,edly. 5eduction of -?@ ratio also increases solubility and
disintegration in the oral cavity.
Di#"nion!* t!/i*it0
They show a linear contraction when setting at 0"=<.
7io*o&ic prop"rti"
The p* of the cement li&uid is .", but the li&uid is rapidly
neutralized by the powder. -* increases rapidly as the cement sets.
2
6espite the initial acidic nature, these cements produce minimal
irritation to the pulp because of &uic, neutralization and the lac, of tubular
penetration of the sized polyacrylic acid molecules.
This excellent biocompatibility with the pulp is one of the strongest
clinical merits of this cement.
Ad1!nt!&"
@ow level of irritation and increased biocompatibility with the pulp.
'dhesion to tooth structure.
Basy manipulation.
'nticariogenic.
Thermal insultor
*ydrophilic and capable of wetting dentinal surfaces.
Di!d1!nt!&"
+f acute proportioning is not done, properties are affected i.e.
solubility and disintegration increases.
>or,ing time is short.
<lean surface is re&uired for adhesion.
'bsorbs water and softens into a gel.
+ncreased solubility in acids.
6ifficult to remove flash.
Cailures occurs at cement-metal interface. 'fter hardening,
polycarboxylate cements exhibit significantly greater plastic deformation;
4
thus the cement is not well suited for use in regions of high masticatory
stress or in the cementation of long-span prosthesis.
"
App*ic!tion
Ised for the cementation of single metal units in low stress areas on
sensitive teeth.
9) T0p" I G*! Iono#"r C"#"nt : ASPA or A*u#inoi*ic!t"
po*0cr0*!t" : A*,"n"!t"
D"-inition
',inmade and Nicholson in !!0 defined glass ionomer cement as
Ka water based cement wherein, following mixing, the glass powder and
the polyal,enoic acid undergo an acid base setting reactionL.
:clean and Nicholson defined 3+< as Ka cement that consists of a
basic glass and an acidic polymer which sets by an acid base reaction
between these componentsL.
Co#poition
Po$d"r
The basic component of a glass ionomer cement powder is a
calcium fuoroalumino silicate glass with a formula of(
Si9
/
-'l
/
9
0
-<aC
/
-Na
0
'lC
4
-'l-9
1
The nominal composition of the glass is listed below(
Ch"#ic!* %"i&ht '()
Si9
/
'l
/
9
0
<aC
/
Na
0
'lC
4
'lC
0
'l-9
1
/!.#
4.4
01.0
2.#
2.0
!.7
7
The raw materials are fused together to a uniform flass by heating
them to a temperature of ##=<. The glass is then ground to a powder
having particles in the range of /# to 2#Fm. glasses high in silica are
transparent, whereas glasses high in calcium fluoride or alumina are
opa&ue.
F*uorid" i !n ""nti!* contitu"nt o- GIC.
- +t lowers the fusion temperature.
- +mproves the wor,ing characteristics.
- +ncreases the strength of the set cement.
- <ontributes to anticarcinogenic property perhaps the
rationale for using 3+< as a luting agent is based on
its ability to release fluoride ions into the underlying
dentin. This helps prevent secondary caries which is
the most cause of failure.
The powder is described as an ion-bleachable glass that is
susceptible to acid attac, when the Si?'l atomic ratio is less than /(.
<ryolite is added to supplement the flexing action of calcium
fluoride and to increase the translucency.
'luminium phosphate improves translucency and adds body to the
cement paste. ;arium glass may be added to provide radiopacity.
Li)uid
The li&uid typically is 1."2E solution of /( polyacrylic acid ?
itaconic acid copolymer 8average molecular weight #,###) in water. The
acid is a polyelectrolyte, which is a homopolymer or copolymer of
unsaturated carboxylic acid ,nown as al,enoic acids.
!
The itaconic acid reduces the viscosity of the li&uid and inhibits
gelation caused by intermolecular hydrogen bonding.
Int"r#o*"cu*!r h0dro&"n /ondin&
Tartaric acid is present in 2E, as an optically active isomer and
serves as an accelerator by facilitating the extraction of ions from the glass
powder. 'lso tartaric acid prolongs the wor,ing time, improves handling
characteristics, enables fluoride contact of glass to be reduced and helps in
the production of bear glasses.
>ater is the basic reaction medium and plays a role in hydrating
reaction products, that is metal polyal,enoate salts and silica gel.
%!t"r "tt!/*" GIC
To extend the wor,ing time, one 3+ formulation consists of freeze
dried acid powder and glass powder in one bottle and li&uid components in
another. The chemical reaction procedures in the same way except that
these cements have a longer wor,ing time and a shorter setting time.
S"ttin& r"!ction !nd !dh"ion to tooth tructur"
The cement sets hydroacid base reaction and consists of / stages.
The first occurs during the initial 2 minutes when the reaction between the
powder and the li&uid forms a silaceous hydrogel. The second stage
re&uires about /1 hours and occurs when a polysalt matrix completely
surrounds all of the initial reaction products.
>hen the powder and li&uid are mixed the following se&uence of
events ta,e place(
i) -olyacid attac,s the glass to release calcium, aluminium, sodium
and fluoride ions.
/#
ii) These ions react with the polyanions to form a salt gel matrix.
iii) The polyacrylic acid chains are cross-lin,ed by <a
MM
in the first 0
hours.
iv) Subse&uently aluminium ions react for atleast 17 hours.
v) The fluorides and phosphates form insoluble salts and
complexes.
vi) The sodium ions form a silica gel.
vii) Some of the sodium ions replace, the hydrogen ions of the
carboxyl groups and the rest combine with fluorine ions.
viii) The cross-lin,ed phase is hydrated by water.
ix) The unreacted portion of glass particles are sheathed by silica
gel.
x) Thus, the set cement consists of an agglomeration of unreacted
powder particles surrounded a silica gel in an amorphous matrix
of hydrated calcium and aluminium polysalts.
xi) The glass ionomer chemically bonds to enamel and dentin. +t
seems that bonding involves an ionic interaction with calcium
and?or phosphate ions from the surface of the tooth structure.
This results in chelation of carboxyl groups of the polyacids with
the calcium in the apatite of the enamel and dentin.
/
5ii) Ro*" o- $!t"r in th" "ttin& proc"
>ater hydrates the cross-lin,ed matrix, thereby increasing the
material strength. 6uring the initial reaction period, this water can be
readily removed by dessication and is called loosely bound water. 'lso at
this stage the 3+ readily absorbs moisture into the glossy matrix resulting
in a compromised material. Therefore, any contact with saliva or oral fluids
has to be prevented for the first /1 hours to prevent early disintegration and
dissolution.
's the setting continues the water becomes tightly bound and cannot
be removed. This hydration is critical in yielding a stable gel structure and
building the strength of the cement.
+!nipu*!tion
The prepared tooth structure and the inner surface of the casting are
cleaned. The tooth surface is cleaned with a slurry of pumice, rinsed and
then dried but not dehydrated. Indue dessication opens up the dentinal
tubules, enhancing penetration of the acidic li&uid.
' glass slab or a paper pad is used for mixing. ' plastic spatula
should be used. Ise of a metal spatula, causes abrasion by the glass
particles of the metal surfaces resulting in discoloration of the set cement.
-?@ ratio for 3+< Type + is .0 ( .
The powder is introduced into the li&uid in large increments and
spatulated rapidly for 0# to 12 seconds. Bncapsulated products typically are
mixed for # seconds in a mechanical mixer and dispensed directly. *and
mixed cements often contain bubbles of larger diameter, which may
contribute to a decrease in strength.
//
The cement must be used before it loses its glossy apperance. The
field must be isolated completely. 9nce the cement has achieved its initial
set 8" minutes), the cement margins should be coated with a varnish.
Pr"c!ution.
Tooth should be conditioned.
Should be protected from moisture and drying during setting.
Should be used before loss of glossy appearance.
Clash should be removed only after cement hardens.
Prop"rti" .
Setting time of 3+< is within 4-7 minutes from the start of mixing.
Ph0ic!* !nd #"ch!nic!* prop"rti";
The /1 hour compressive strength of 3+< ranges from !0-//4:-a,
tensile strength being 1./-2.0:-a and elastic modulus of 0.2-4.1 3-a.
Strength increases between /1 hours and year and is significantly
increased by initial protection from moisture. @ow values of elastic
modulus ma,e them susceptible for elastic deformation increase of high
masticatory stress.
The bond strength of 3+< to dentin is 0-2:-a. The bond strength
can be improved by treatment of the dentin with an acidic leaching agent
followed by an application of a dilute a&ueous solution of Ce<l
0
. The 3+<
bond well to enamel, stainless steel, tin-oxide plated platinum and gold
alloy.
/0
So*u/i*it0 !nd diint"&r!tion
' /1 hours solubility for 3+< in *
/
9 is #.1-.2E solubility is less in
acidic solutions and also depends on initial exposure to water.
Cilm thic,ness for 3+< is //-/1Fm.
7io*o&ic prop"rti".
i) 5esistance to microlea,age
The cement bonds adhesively to tooth structure and prevents ingress
of fluids at the interface. This is probably because the coefficient of
thermal expansion of 3+< is similar to that of the adAacent tooth structure
particularly the dentin.
ii) 'nticariogenic due to the release of fluoride ions.
iii) -ost cementation sensitivity
This is related to the p* and the length of time that this acidity
persists. The p* of the mix at / minutes after mixing is /.00 and it
increases upto 2.4" in /1 hours but never reaches neutral p*. 'lso if the
tooth is excessively dehydrated before cementation, the tubules open up
allowing acids to seen through. +f the crown is overfilled, the excessive
hydraulic pressure re&uired to remove excess cement caused sensitivity.
Ad1!nt!&"
i) <hemical adhesion to tooth structure.
ii) 'nticariogenic.
iii) Bsthetic properties.
iv) Base of manipulation.
/1
v) They possess low film thic,ness and maintain relatively constant
viscosity for a short time after mixing. This results in improved seating
of cast restorations.
Di!d1!nt!&"
i) @ow film thic,ness can cause inhomogenous distribution of
curing stresses and microcrac,s resulting in cementation failure.
ii) @ow elastic modulus
iii) Susceptibility to moisture attac, and subse&uent solubility if
exposed to water during the initial setting period.
iv) Barly exposure to moisture and saliva decreases the ultimate
strength.
v) Susceptibility to dehydration and cohesive failure due to
microcrac,s.
vi) -ost cementation sensitivity.
App*ic!tion
Ised as permanent luting agent for cast posts, metal inlays, onlays,
crowns, C-6s and all-ceramic crowns to tooth structure, amalgam,
composite core build ups.
<) R"in Co#poit" C"#"nt
5esin cements are variations of filled ;+S-3:' resin and other
methacrylates.
Co#poition
The early resin cements were primarily poly8methylmethacrylate)
powder with inorganic fillers and methyl methacrylate li&uid. The
/2
composition of most modern resin based cements is similar to that of
composite resin materials. ;ecause most of the prepared tooth surface is
dentin, monomers with functional groups that have been used to induce
bonding to dentin are often incorporated in these resin cements. They
include organophosphonates, hydroxyethyl methacrylate 8*B:') and the
1-methacryloxyethyl trimellitic anhydrite 81-:BT') system.
The phosphonate cements also contain a silanated &uartz filler. The
phosphonate is very sensitive to oxygen, so the margins of the casting have
to be protected until setting has occurred. The phosphate end of the
phosphonate reacts with calcium of the tooth or with a metal oxide.
The 1-:BT' cement is formulated with methyl methacrylate
monomer and acrylic resin filler and is catalyzed by tri-butyl borax.
They polymerize through conventional peroxide amine induction
systems 8chemically initiated polymerization) or by photoinitiation or a
combination of both 8dual-cure systems).
+!nipu*!tion
The chemically activated systems are available in powder-li&uid
system or as two paste systems. The peroxide initiator is in one component
and the amine actiator is contained in the other. The components are mixed
on a paper pad for /#-0# seconds. The restorations should be promptly
seated and excess cement should be removed immediately.
@ight activated systems are single component systems. The time of
exposure to light needed for polymerization of the resin cement is
dependent on the light transmitted through the ceramic restoration. +t
should never be less than 1# seconds.
/4
The dual cure systems are /-component systems. The part of the
cement that does not come in contact with the light source is cured
chemically.
Adh"ion to tooth tructur"
i) 'pplication of an acid or dentin conditioner to remove the
smear layer and smear plus.
ii) The tubules are opened and widen with demineralization of
the top / to 2Fm of dentin.
iii) The acid dissolves and extracts the apatite mineral phase
that normally covers the collagen fibres of the dentin matrix and
opens /# to 0#nm channels around the collagen fibres. These channels
provide an opportunity to achieve mechanical retention of
subse&uently placed hydrophilic adhesive monomers. +f application of
the conditioner exceeds 2 seconds, a deeper demineralized zone
results which resists subse&uent resin infiltration. +f complete
infiltration of the collagen by the primer does not occur, the collagen
at the deeper demineralized zone will be left unprotected and
subAected to future hydrolysis and final brea,down.
iv) 'fter demineralization, the primer, a wetting agent such as
*B:' is applied.
The agent is bifunctional, in that it is both hydrophilic, which
enables a bond to dentin, and hydrophobic, which enables a bond to the
adhesive. The primer is applied in multiple coats to a moist dental surface.
:ultiple coats are re&uired to replace the water in the damp dentin with the
resin monomers and to carry the adhesive material into the tubules. The
/"
primer is gently dried so as not to disturb the collagen networ, but to
remove any remaining organic solvents or water.
v) 'dhesive resin is then applied to the KprimedL surface to
stabilize the primer infiltrated demineralized dentin.
5etention is achieved by the following means(
+nfiltration of resin into etched dentin, producing a micromechanical
interloc,ing with the open tubules forming resin tags; which
underlies the hybrid layer of resin interdiffusion zone.
'dhesion to enamel through the micromechanical interloc,ing of
resin to the hydroxyapatite crystals and rods of etched enamel.
'dhesion to dentin, involving penetration of hydrophilic monomers
through a collagen layer overlying partially demineralized apatite of
etched dentin.
vi) The use of dentin bonding agents has somewhat
compensated for the polymerization shrin,age evident with all resins.
Prop"rti"
Their properties on dependent on compositional differences,
amounts of diluent monomers and filler levels.
Setting time 1-2 minutes at 0"=<.
<ompressive strength 2/-//1:-a.
Tensile strength 0"-1 :-a.
Blastic modulus ./-#." 3-a.
;ond strength to dentin -/1 :-a with bonding agent.
/7
Girtually insoluble in oral fluids
Cilm thic,ness 0-/#Fm.
Bxhibits polymerization shrin,age which is an impediment to
complete dentinal adhesion.
They are pulpal irritants due to the presence of bleachable
monomers.
7ond tr"n&th in T"nion +P!
Su/tr!t" R"in c"#"nt
6entin 8unetched)
Bnamel 8etched)
Ni-<r-;e alloy
Sandblasted
Blectrolytically etched
Type +G 3old alloy
Sandblasted
Tin-plated
1E
2.#
/1.#
/".1
//.#
/2.2
Ad1!nt!&"
a) 5esin cements bond chemically to resin composite restorative
materials and to silanated porcelain. They increase the
fracture resistance of ceramic materials that can be etched
and silanated.
b) They demonstrate good bond strengths to sandblasted base
metal alloys, the 1-:BT' resin cements show strong
adhesion as a result of chemical interaction of the resin with
an oxide layer on the metal surface. Noble alloys may be
/!
electroplated with tin to increase the surface area for bonding
and enable a chemical bond with tin oxide.
c) :ost resin adhesives are filled, 2#E to "#E by weight, with
glass or silica due to which they exhibit high compressive
strength, resistance to tensile fatigue and virtual insolubility
in the oral environment.
d) +mproved marginal wear resistance.
e) Some of the formulations contain ytterbium tori fluoride,
other include a barium fluorosilicate filler and have fluoride
release and cariostatic potential.
f) 9ffer ade&uate retention for short, tapered crown
preparations.
Di!d1!nt!&"
a) *igh filler content increases viscosity, which reduces flow
and increases film thic,ness and chances of incomplete
seating of the restoration.
b) polymerization shrin,age.
c) +rritant to the pulp.
Their ability to adhere to multiple substrates high strength,
insolubility and shade matching potential have made them the adhesives of
choice for cementation of the following(
5esin composite inlays and onlays.
'll-ceramic inlays and onlays.
Geneers, crowns, C-6s.
0#
Ciber reinforced composite restorations.
@uting base metal resin bonded bridges 8K:arylandL
type).
0
=) R"in +odi-i"d G*! Iono#"r : H0/rid Iono#"r
To overcome inherent drawbac,s of 3+< such as moisture
sensitivity and low early strength, polymerizable functional groups have
been added to the formulations to impart additional curing processes and
allow the bul, of the material to mature through acid-base reaction. This
group of materials are also ,nown as light cured 3+<s, dual cure 3+<s
8light cure and acid base reaction), tri-cure 3+<s 8dual cure and chemical
cure), resin ionomers, compomers and hybrid ionomers.
Co#poition !nd "ttin& r"!ction
The powder consists of ion-bleachable glass and initiators for light
or chemical curing or both. The powder blends is formed of glass, tartaric
acid and polyacrylic acid.
The li&uid component may have only water or polyacrylic acid
modified with *B:' monomers and methacrylate monomers. They
contain hydroxyl groups that ma,e them water soluble. These are the
simplest form of resin ionomers.
They are mixed in the same way as conventional 3+<s and remain
wor,able for # or more minutes provided they are not exposed to light.
The reaction is dual-setting once exposed to light.
a) 'cid base reaction ( <alcium fluoroalumino silicate glass 8base) and
polyacrylic acid N calcium and aluminium polysalt hydrogel.
b) Cree radical or photochemical polymerization *B:' and
photochemical initiator ? activator
0/
Po*0 H"#! +!tri5
Thus two matrices are formed; a metal polyacrylate salt and a
polymer. The initial set is a result of polymerization of *B:'. The acid
base reaction serves only to harden and strengthen the already formed
polymer matrix.
C*! I #!t"ri!*
Co#poition
a) Powder component( <alcium fluoroalumino silicate glass,
polyacrylic acid and tartaric acid.
b) Liquid component (replaces water): >ater ?*B:', other
difunctional hydroxydimethacrylates 8such as ethyleneglycol
dimethacrylate) and bis-3:'.
c) +nitiator ? 'ctivator.
Ch"#ic!**0 po*0#"ri>"d #!t"ri!*.
+nitiator *ydrogen peroxide.
'ctivator 'scorbic acid.
<o-activator <upric sulphate.
Li&ht !cti1!t"d #!t"ri!*
Gisible light photochemical initiator <amphor&uinone
'ctivator Sodium p-toluenesulphinate
-hotoaccelerator ethyl 1-N n-dimethylaminobenzoate.
00
The two matrices do not interpenetrate but form separate phases. To
prevent phase separation. <lass ++ materials 8Gitrebond) have been
formulated.
+n this material, polyacrylic acid 8-'') is replaced by modified
-''s.
+n these modified -''s, a small percentage of D<99* is converted
to pendant unsaturated groups by a condensation process. They are
condensed with methcrylate polymers to have terminal D<99* and D<*
0
groups.
01
The <lass ++ materials uses an a&ueous solution containing /2E to
12E of modified -'' and /E to 1E *B:' along with initiator system
of camphor&uinone and diphenliodonuim chloride with a glass of the
following percentage composition ( Si9
/
/4.71E, 'l
/
9
0
#.7#E, -
/
9
2
#.!1E, N*
1
C 0.0/E, 'lC
0
/#.44E, Na
0
'lC
4
#.42E, .n9 /#.44E, :g9
/./E, Sr9 /.22E.
9n mixing and activation by light, the *B:' polymerizes to form
poly *B:'.
The modified -'' copolymerizes with *B:'; thus poly *B:'
will be chemically lin,ed to the polyacrylate matrix and phase separation
will not occur. 'lso the modified -'' further polymerizes to form a cross-
lin,ed -'' which increases the strength of the cement.
The matrix of such a cement will contain both ionic and covalent
crosslin,s.
Prop"rti"
<ompomers have both advantages and disadvantages compared to
conventional 3+<s.
They have improved setting characteristics. There is a longer
wor,ing time because *B:' slows the acid-base reaction, and yet, they
set sharpely once the polymerization reaction is initiated by light. They are
also resistant to early contamination by water because of the formation of
02
an organic matrix and so do not re&uire protection by varnish. This
combination of properties is clinically appealing.
These cements have compressive and diametral tensile strengths
greater than zinc phosphate, polycarboxylate and 3+< but les than resin
composite.
/1 hours in :-a
<lass + <lass ++
<ompressive
strength
!1 20-!4
Clexural - /2.2
Tensile /.!-00.! ./-/.1
'dhesion
8dentine)
1" 4./-.0
Their adhesion to enamel and dentin, and their fluoride release
pattern is similar to 3+<. They also bond to resin composite. They have
cariostatic potential and show resistance to marginal lea,age. The biggest
advantage is ease of mixing and use, because multiple bonding steps are
not re&uired. They also have ade&uately low film thic,ness 8#-//Fm).
They have a bond strength to dentin of about #-/:-a without bonding
agent and 1-/#:-a with bonding agent.
' significant disadvantage of the resin ionomers is hydrophilic
nature of poly*B:' which results in increased water resorption and
subse&uent plasticity and hygroscopic expansion. 'lthough initial water
sorption may compensate for polymerization shrin,age stress, continual
water sorption has deleterious effects. -otential for substantial dimensional
change contraindicates their use with all-ceramic feldspathic-type
restorations.
04
Their use for cementing posts in non-vital teeth is &uestionable
because of the potential for expansion induced root fracture.
They lac, translucency and the presence of free monomers in the
freshly mixed cement presents concerns regarding biocompatibility.
6imetracrylates may elicit allergic response and therefore careful handling
by dental personnel is re&uired during mixing.
+t is ,nown that eugenol containing materials inhibit the cross-
lin,ing of resin adhesives. They should not be used for final cementation
when the luting agent for interim restoration has been eugenol containing
provisional materials.
App*ic!tion
@uting metal or porcelain fused-to-metal crowns and C-6s to tooth,
amalgam, composite resin or glass ionomer core build ups.
Su##!r0 !nd Conc*uion
@uting agents possess varied complex chemistries that affect their
physical properties, longevity, and suitability in clinical situations. +t
appears a single adhesive will not suffice in modern day practice. To date,
no adhesive can completely compensate for the shortcomings of
preparation retention and resistance forms or ill-fitting, low strength
restorations. -ractitioners must be aware of the virtues and shortcomings of
each cement type and select them appropriately.
0"