Resin cements continue to evolve with

refinements engineered by the manufacturers.

One of the big changes in recent years has been
the development of all-in-one resin cements,
which are said to eliminate the need for a dentin
bonding system when placing indirect
restorations.
These cements are variously la-beled as all-in-one
cements, universal cements, self-adhesive
cements, or adhesive cements. The classification
by the manufacturers is not always clear, because
traditional resin cements are now called adhesive
cements as well.

 Nevertheless, it appears that there are now two

groups of resin cements: a group that requires a dentin
bonding system before use and a group of cements for
which the use of a bonding agent is optional.
The bonding mechanism of these resins is based on an
acid-base link to the calcium in hydroxyapatite in
dentin and enamel while maintaining the physical
properties of resin cementan approach that makes
the bonding to dentin similar to a resin-modified glassionomer cement without the need of the glassionomer component.
1 A list of current self-adhesive resin cements is given
inTable 1.

Figure 1 New incremental dual dispenser

for RelyX Unicem.

 PHYSICAL PROPERTIES OF RESIN CEMENTS

There exists an international standard, ISO 4049, that sets forth a
group of minimum standards for the physical properties of resin
cements,2 including the self-adhesive cements. These standards are
identical to the ANSI/ADA specification No. 27.3
The ISO standard addresses primarily resin-based composites, but
includes specific requirements for resin-based luting agents. Even
though the ISO standard is a voluntary one, many manufacturers of
resin cements are in compliance with the ISO standard and indicate
that on the package or the enclosed literature.
The ISO standard requires a minimum value for the transverse
flexural strength (50 MPa), radiopacity (equivalent to aluminum),
and a limit on solubility in water. At this time there is no
requirement on adhesive properties; however, most manufacturers
report adhesive strength as measured by the shear bond strength
test.4 In selecting a resin cement, compliance with the ISO standard
is a good starting point.

COMPOSITION OF RESIN CEMENTS AND SELF-ADHESIVE RESIN

CEMENTS
Resins in this case are defined as blends of polymerizable
monomers of methacrylates, dimethacrylates, and
polymethacrylates (which have recently been included into the
blend as well). For the self-adhesive resin cements, additions to the
resin blend consist of highly acidic resin monomers,
monomethacrylates, multifunctional methacrylates, and at least
one of the new cements includes 4-methacryl-oxyethyl trimellitic
acid (4-MET).
The inclusion of the acidic monomers creates a self-etching resin,
increasing the adhesive properties. This concept of self-etching
finds its origin in the development of the self-etching adhesives.
Further additives are included to increase the bond strength to
metals (eg, 4-MET) and to resins that bond to ceramic interfaces.

 The first highly acidic monomer was an acrylic chain on which

phosphoric acid groups were grafted. Since then, other acidic
monomers have been introduced. The goal is to include the dentin
bonding agent and a ceramic bonding system or metal bonding
system into the resin cement and have the entire assembly
polymerized at once.
Several manufacturers have included a fluoride component as
well.5,6 This practice is of dubious value, as the acrylate resins are
very hydrophobic. The mechanisms of fluoride release and of
maintaining low water absorption are mutually exclusive. Cement
that meets the ISO standard on water solubility cannot release a
clinically effective amount of fluoride. One manufacturer carefully
states that its product "contains" fluoride and claims a release of 7
ppm to 9 ppm independent of the exposed surface area.5 In the
authors opinion, whether a cement contains fluoride or not should
not be a factor in the product selection of resin-based cements.

 For two of the products in Table 1 (EMBRACE Wetbond,

Pulpdent Corporation, Watertown, MA; and MonoCem SelfAdhesive Resin Cement, Shofu Dental Corporation, Menlo Park, CA),
it is recommended that the cement be applied to moist dentin, not
dry dentin.5,6 It is claimed that the uncured resin is hydrophilic, but
that the cured resin is hydrophobic.7 The authors hope to
investigate this claim and report the findings in the near future.
The viscosity of the resin cements have been significantly reduced
over the last few years. The reason for the change is primarily the
introduction of new delivery systems (see next section). To achieve
these low viscosities, the particle size of the inorganic fillers has
been greatly reduced. Most cements now have an average particle
size well below 1 m. Submicron or nanofiller particles are
becoming a significant component of resin cements and
composites.

The filler content of the cement is kept at or below 50% by volume.

The second step in reducing the viscosity was obtained by using
very low molecular weight monomers as diluents (2hydroxyethylmethacrylate [HEMA], tetraethyleneglycol
dimethacrylate [TEGDMA]).

The result of using these diluents is that the polymerization

shrinkage of the cement increases to about 4% by volume (1.2%
linearly), which is of little consequence for cement.