Resin Luting cements (2nd edition)

2
 Uses
 Types Composition
 Reaction
 Properties
 Manipulation
Items to be covered

Cementation of:
1. Indirect restorations: including veneer, inlay,
crown & bridge.
2. Posts: prefabricated posts.
3. Orthodontic brackets.
Note: orthodontic bands are commonly cemented
by glass ionomer cements (GIC). (Phillips)
3
Uses (applications)

Cementation of:
4. Different types of materials, including:
 Ceramics
 Resin composites: laboratory-processed (indirect)
 Metals: if extra retention is needed
4
Uses (applications) (continued)

5. Resin cements are the material of choice for
cementation of ceramic veneers (restorations).
 Reduce fracture incidence of ceramics:
* High strength
* Good bond strength
 Translucent, good esthetics & various shades
5
Uses (applications) (continued)

1. Light-cured
2. Chemical-cured (self-cured)
3. Dual-cured: combination of chemical & light activation
7
Types
According to method of
activation

 Less common.
* To avoid the potential incomplete
polymerization under a prosthesis.
 Not cure (polymerize) properly with large inlays &
crowns.
* Light would be unable to penetrate to the
full depth of inlay & crown.
8
Light-cured resin cements
Why?
Why?

 Recommended for bonding the veneer.
* More color stability
* More working time
than the self-cured or dual-cured versions.
 Cementation of:
* Thin translucent prosthesis (ceramic & resin)
* Ceramic veneers
* Orthodontic brackets (Craig)
9
Light-cured resin cements
Uses

Cementation of:
 All types of restorations. (Phillips)
 Metal (cast) restorations: if extra retention is needed.
 Translucent restorations: if thickness > 2.5 mm.
(Phillips, p. 330)
10
Chemical-cured resin cement
Uses

Cementation of:
 Inlays: chemical polymerization is preferred.
* To ensure maximum polymerization in the less
accessible proximal areas.
* Clinical performance: chemical-cured > dual-cured.
(Contemporary: p. 784)
11
Chemical-cured resin cement
Why?
Uses

 Most commercial products
 Suitable working time
 High degree of conversion even in areas not reached by light.
(Craig)
 Slow reaction until exposed to light → at which point the
cement hardens rapidly.
12
Dual-cured resin cement

Cementation of:
 Translucent restorations: if thickness < 2.5 mm. (Phillips, p. 330)
13
Dual-cured resin cement
Uses

 Unfilled resin: without filler
 Composite resin cement: contains filler
14
Types
According to development
& the presence of filler

(1950s)
 Without filler
 High polymerization shrinkage
 Poor biocompatibility
 Unsuccessful
15
Unfilled resin

 Contains filler.
 Greatly improve properties.
 ↑ filler loading (content) → ↓ resin content → ↓ problems of
resin, such as ↓ polymerization shrinkage.
16
Composite resin cement

 Filler content: less than composite restorative material
* To ensure low film thickness (required for cementation).
17
Composite resin cement

1. Conventional resin cement: not adhesive
2. Adhesive resin cement
3. Self-adhesive resin cement
(Introduction to dental materials, p. 221,222)
18
Types According to adhesion

 Aesthetic: used when aesthetic is important
 Light- & dual-cure
 Not adhesive
19
Conventional resin cement

 Adhesive: improve the adhesive bond to metal
 Chemical- / dual-cure
 Still require a dentin bonding agent
20
Adhesive resin cement

 Self-adhesive
 Not require any pretreatment of tooth: not require etching &
bonding
 Single step application: etching, priming & bonding in
a single material
 Simultaneous adhesion to tooth & restoration
21
Self-adhesive resin cement

* Become popular.
 Simpilicity
 Lowest post-cementation sensitivity.
 Universal adhesive.
 Good bond strength to dentin. (contemporary, p. 781)
22
Self-adhesive resin cement (continued)
Why?

Very similar composition to restorative composites. (Craig)
Four major components:
* Organic resin matrix
* Inorganic filler
* Silane coupling agent
* Initiator-accelerator system
23
Composition

Combine:
* MDP with Bis-GMA (Craig)
* or 4-META & MMA in the liquid, and PMMA in the powder.
 MDP & 4-META bond chemically to metal oxides.
 Notes: * MDP: contains phosphate group.
* 4-META: contains carboxylic acid groups. (Craig)
24

25
Introduction to dental materials, p. 222

Acidic functional monomer:
* Etch the tooth.
* Based on phosphates & phosphonates.
* Bond to base metal alloys (metal oxides) & ceramics.
* Simultaneous adhesion to tooth & restoration
* Examples: MDP & PENTA: contain phosphate groups.
26

Alkaline glass: acid neutralizing fillers, such as fluoroalumino silicate
(found in glass ionomers).
* Note: the remaining acidity is neutralized by alkaline glass.
(Craig)
30

Alkaline amines become inactive in an acidic environment.
* Therefore, a new initiator system has to be developed.
*Each product has its own acid-resistant initiator/accelerator
system. (Introduction to dental materials, p. 222,223)
31

 RelyX ARC (3M/ESPE)
32
Commercial products
 Super-Bond C&B (Sun Medical) → contains 4-META.
 Panavia 21 (Kurary) → contains MDP.

34
Super-Bond C&B (Sun Medical)

* RelyX Unicem (3M/ESPE): contains phosphoric acid-modified methacrylates
* SmartCem2 (Dentsply): contains PENTA.
* Maxcem Elite (Kerr):contains glycerol dimethacrylate dihydrogen phosphate
* Panavia SA Cement Plus (Kurary): contains MDP(dipentaerythritol pentacrylate phosphate)
* SpeedCEM Plus (Ivoclar Vivadent): contains MDP.
* SoloCem (Coltene): contains MDP & 4-META.
36
Commercial products

40
Panavia SA Cement Plus (Kurary)

41
SpeedCEM Plus (Ivoclar Vivadent)

 Free radical polymerization reaction.
 Activator → activates the initiator → release free radical
→ initiate the polymerization reaction.
 Acidic groups (phosphate & carboxylate) bind with calcium in
hydroxyapatite.
 At later stages, the remaining acidity is neutralized by alkaline glass.
44
Reaction

 Anaerobic setting reaction:
* Some commercial products do not set in the presence of
oxygen.
* Oxygen barrier (protection): a polyethylene glycol gel
(Oxyguard II) can be placed over the restoration margins
- Oxygen barrier (protection).
- To ensure complete polymerization. (Contemporary, p. 708)
45
Reaction (continued)

47
Properties
 Degree of conversion
 Cytotoxicity
 Mechanical properties
 Water sorption & solubility
 Film thickness
 Postoperative sensitivity
 Fluoride content & release
 Translucency & esthetics
 Bonding to the tooth structure

In dual-cured cements:
 Light-curing → ↑ degree of conversion →
* ↑ mechanical properties
* ↓ residual monomer → ↓ cytotoxicity of dual-cured cements.
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Degree of conversion

49
Cytotoxicity
Unfilled resin > composite resin cement.
In dual-cured resin cements, light-curing → ↓ cytotoxicity.
After 7 days, Bis-GMA-based dual-cured cements are less cytotoxic than
zinc polyacrylate.
Why?
Why?

50
Cytotoxicity (continued)
 Adhesive resin cements are less biocompatible than glass ionomer
cement, especially if they (resin cements) are not fully polymerized.

51
 Pulp protection: important when the thickness of remaining
dentin is less than 0.5 mm.
 In self-adhesive resins: slightly acid-soluble glass filler reacts with
the acidic monomer → increases the pH to a neutral level.
(Introduction to dental materials, p. 222)
Cytotoxicity (continued)

52
 Compressive strength
* Resin cements (dual- & light-cured) > acid-base cements.
 ↑ Filler content & ↑ degree of conversion → ↑ mechanical properties.
Mechanical properties

53
 In dual-cured resin cements, light-curing → ↑ mech prop.
 Self-adhesive resin cements have slightly (somewhat) lower
mechanical properties than conventional resin cements.
Mechanical properties (continued)
Why?

54
 Virtually insoluble in oral fluids. (Phillips)
 Resin cements < resin-modified glass ionomer.
Notes:
* However, discoloration of the cement line may occur after
a prolonged period. (Craig)
* Shrinkage: 2–5%.
Water sorption & solubility

55
Water sorption:
 Self-adhesive resin cement > conventional.
* Unreacted acid groups → ↑ water sorption. (Craig)
Water sorption & solubility (continued)

56
 Low viscosity & film thickness. (Craig & Phillips)
 The filler content is lower than composite restorative material.
* To ensure low film thickness.
Film thickness
Why?

57
= Post-cementation sensitivity = Post-treatment sensitivity.
(Contemporary: p. 778, 781)
 Self-adhesive resins:
* Lowest incidence of post-cementation sensitivity.
- Because the dentin does not need to be etched with
phosphoric acid. (Craig)
- Significant advantage.
Postoperative sensitivity
Why?

58
 Low fluoride content (around 10%) less than glass ionomer & resin-
modified glass ionomer.
 Fluoride release
* Decrease rapidly with time.
* Its beneficial effects have not been clinically proven.
Fluoride content & release

59
 Various shades & translucencies.
 Amines degrade over time, altering the shade of the cement.
(Craig)
 Discoloration of the cement line may occur after a prolonged
period. (Craig)
 Note: resin cements are the material of choice for
cementation of ceramic veneers (restorations).
Translucency & esthetics

60
 Self-adhesive resin cement is not recommended for bonding of
ceramic veneers.
* Ceramic veneers are cemented by light-cured resin
cements.
* Because of the need for high esthetics.
(Introduction to dental materials, p.223)
Translucency & esthetics (continued)
Why?

61
 Micromechanical retention (interlocking) by acid etching.
 Chemical bond between acidic groups (if present) & calcium in
tooth structure.
Bonding to the tooth structure

62
 Self-adhesive resin cement
* Not require any pretreatment of tooth: not require etching
& bonding
* Single step application: etching, priming & bonding in
a single material
* Simultaneous adhesion to tooth & restoration
Bonding to the tooth structure (continued)

63
Acidic functional monomer
 Etch the tooth.
 Based on phosphates & phosphonates.
 Bond to tooth, base metal alloys (metal oxides) & ceramics.
 Simultaneous adhesion to tooth & restoration.

64
 Bond strength to dentin: comparable to resin cements.
 Bond strength to enamel: less than conventional resin cements.
 Selective etching (with phosphoric acid gel to enamel only) → ↑ bond
strength to enamel.

65
 Notes: enamel bonds are compromised with most self-etching
primers.
 This deficiency may be overcome using the “selective etch” technique.
(Art & Science, p. 482)

66
 Self-adhesive resin cement is not suitable for bonding of orthodontic
brackets.
* Because bonding to enamel is less than that achieved with
the etch-and-rinse & self-etching dentin-bonding agents.
Why?

69
Manipulation
 The procedure for preparing tooth surfaces remains the same for
each system.
 But the treatment of the prosthesis differs depending on the
composition of the prosthesis. (Phillips)

70
Resin-to-tooth bonding
 Etch-and-rinse or self-etch bonding systems.
 Etch-and-rinse
* Phosphoric acid etching, then rinsing & air-drying.
* Bonding agent application → form resin tags → ready for
luting of restoration with resin cement.
 Self-adhesive resin cements do not require etching & bonding.

71
Resin-to ceramic bonding
Silica-based or glass-matrix ceramics
 Examples: feldspathic porcelain, leucite-reinforced &
lithium disilicate-reinforced ceramics.
 Hydrofluoric (HF) acid etching (5–10%), rinsing & air- drying.
 Silane coupling agent is applied.

72
Resin-to ceramic bonding (continued)
 After try-in & prior to applying the silane, cleaning the ceramic surface with
isopropyl alcohol, acetone or phosphoric acid is needed to remove any surface
contaminants, such as saliva.

73
 For some silane products, it is recommended that a phosphoric acid solution is
added to the silane to hydrolyse it prior to its application.
 Other silane products are already hydrolysed with limited shelf life. (Introduction
to dental materials, p.224)

74
Introduction to dental materials: p. 223

75
Silica-based or glass-matrix ceramics (continued)
 Resin cements are the luting agent of choice.
 Self-adhesive resin cements have lower bond strength to etched
glass-matrix ceramics than conventional resin cements. (Art & Science, p.
159)
Why?

76
 Oxygen barrier (protection): some products of resin cements do not set in the
presence of oxygen (anaerobic setting reaction), such as Panavia 21.
* A polyethylene glycol gel (Oxyguard II) can be placed over the
restoration margins.
→ Oxygen barrier (protection).
→ To ensure complete polymerization.
Why?

77
 Note: sandblasting with alumina particles (airborne- particle
abrasion):
* Immediate lower the flexural strength of feldspathic
porcelains & lithium disilicate-reinforced ceramics.
* ↓ bond strength when HF is not used.

78
 The primary source of retention remains the etched porcelain itself.
 Silanation → only a modest ↑ in bond strength.
 However, silanation is recommended.
→ ↓ marginal leakage & discoloration.
Why?

79
Polycrystalline ceramics
 HF etching does not improve the bond strength.
* Because polycrystalline ceramics do not contain a glass
matrix. (Art & Science, p. 158)
 Newest protocols: (Art & Science, p. 158)
 Airborne-particle abrasion.
 Tribochemical silica coating, followed by silane application.
 Primers or silane mixed with functional monomers, such as 10-MDP.
Why?

80
Polycrystalline ceramics (continued)
 Micromechanical retention plays more important role than chemical
bonding. (Art & Science, p. 158)
 Zirconia restorations:
* Should be cemented with resin-modified glass ionomer or
self-adhesive resin cement. (Art & Science, p. 508)
* MDP-based resin cements → ↑ adhesion to zirconia.

81
Zirconia restorations: (continued)
 Sandblasting is controversial.
 There is a definite risk in the use of air particle abrasion,
→ conversion to monoclinic & substantial weakening.

82
 Air abrasion with alumina, followed by MDP-based self-adhesive
resin cements → form stable Zr–O–P bonds on the zirconia
surface & improve its bond strength. (Craig, p. 281,282)
 Tribochemical coating using silica-modified alumina particles,
followed by silane application is also efficient. (Craig, p. 281)

83
 The combination of mechanical and chemical
pretreatment is recommended for bonding to zirconia.

84
A note on zirconia restorations
 Try-in → contamination with saliva.
 Zirconia has a strong affinity for proteins found in saliva & blood.
 These proteins cannot be removed with phosphoric acid.
 NaOH solution (Ivoclean, Ivoclar Vivadent), for 20 seconds, remove
these proteins. (Art & science p. 508)

89
Resin-to-metal bonding (briefly)
 MDP & 4-META: the metal oxides on the surface of base metal
& tin-plated noble alloys contributes to the bond strength
(chemical bond) when resin cements contain MDP or 4-META.
(Phillips)
 Tin plating improves the retention of noble alloys.
 Noble alloys → lack of metal oxide on the surface.
 Tin plating → tin can form tin oxide on the surface.
Why?

90
Resin-to-metal bonding (continued)
Metals are best prepared by sandblasting (airborne-particle
abrasion) with alumina particles.
 ↑ retention by 64%. (Contemporary, p. 781)
 Creates a roughened higher surface area for
bonding.
 Alumina coating → aids in oxide bonding of
Phosphate-based adhesive system.
(Contemporary, p. 697)

91
Tribochemical silica coating (blasting with silica-coated alumina
particles), followed by silane application is adequate.
 Types: (Introduction to dental materials, p. 227)
 Rocatec: laboratory-based system
 Cojet: chair-side system
 Disadvantages: (Introduction to dental materials, p. 228)
 Multiple steps → ↑ likelihood of errors
 Need special equipment

92
 Metal primers are developed, but the research results are
inconsistent. (Craig, 280)
 Electrolytic etching is not popular.
* Requires high degree of skill & special equipments.
 Note: alloy etching and macroscopic retention mechanisms
have become obsolete.
(Contemporary, p. 697)
Why?

93
Resin-to-resin bonding
 Introduction: (Introduction to dental materials, p. 229)
 One might imagine that resin-to-resin bonding should be free of
problems, this is, in fact, not the case.
 In particular, there have been problems of debonding between the luting
resin & composite inlay.
 Oxygen inhibition layer does not exist.
 The luting resin has to bond directly to fully cured resins.
 This is similar to repairing a fractured composite restoration with new
composite resin.

94
Resin-to-resin bonding (continued)
 Roughened by grit-blasting (alumina sandlasting).
 Phosphoric acid etching → clean the surface.
 HF acid is not recommended.
* HF causes degradation of the composite surface
by etching away the silica glass → leaving a weak
& porous polymer matrix. (Craig, p. 282)
 Tribochemical technique → silica layer, then silane
application.
Why?

95
Resin-to-resin bonding (continued)
The problem of resin-to-resin bonding has not yet been
resolved satisfactorily, & thus will continue to be an area
of research interest.

96
A note on “try-in” pastes
 Same shade as the resin cement.
 Help with shade selection.
 Glycerin-based.
 Water-soluble.
 After shade selection → rinsed away with water spray.
(Craig & Phillips)

97
Try-in gel (NX3 Nexus, Kerr)

98
A note on temporary cementation
Eugenol-free interim (temporary) luting agent should be
used.
 Because eugenol inhibits polymerization of the resin.
Why?

99
References
Sakaguchi R, Ferracane J, Powers J. Craig's restorative dental materials. 14th ed.
St. Louis, Elsevier; 2019. p. 280–282, 289–292.
Ritter AV, Boushell LW, Walter R. Sturdevant's art and science of operative
dentistry. 7th ed. St. Louis, Elsevier; 2019. p. 157–159, 297, 443, 482, 508.

100
References (continued)
Rosenstiel SF, Land MF, Fujimoto J. Contemporary fixed prosthodontics. 5th ed. St. Louis, Elsevier;
2016. p. 691, 696–698, 708, 777–781, 784.
Van Noort R, Barbour ME. Introduction to dental materials. 4th ed. Mosby Elsevier; 2013. p.
221–229.
Anusavice KJ, Shen C, Rawls HR. Phillips' science of dental materials. 12th ed. St. Louis, Elsevier; 2013. p.
311, 329, 330.

Resin Luting cements (2nd edition)

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