LUTING CEMENTS

Presented by
Dr. Smitha .Ravindran

INTRODUCTION

1/11/2015

 Definition:
Dental cement used to attach indirect restoration to prepared teeth
is called luting cement (GPT).

Luting -Latin word lutum

which means mud and is often used to moldable substance to seal a
space

1/11/2015

History
Early 20th century
Zinc oxide phosphoric acid, Zinc oxide eugenolate, Silicate glass,
Phosphoric acid cement

Until 1970s
Zinc phosphate cement
zinc oxide eugenol cement
silicate cement

1/11/2015

 Zinc phosphate cement -most popular material.

solubility and lack of adhesion

Glass ionomer cements- release fluoride

Resin cements reduced solubility and lack of

adhesion

1/11/2015

Ideal Properties Of Dental Cements

Biological properties
Mechanical properties
Physical properties

1/11/2015

Biological properties
Biocompatible
- non interactive, non toxic , low allergic
potential
Solubility in saliva or liquids
Prevent caries at the restoration-tooth
interface
Antimicrobial properties
Micro leakage
1/11/2015

Mechanical properties
Withstand masticatory and para functional
stresses
-warm and wet oral environment

Resist functional forces-sufficient strength to

resist fracture and also longer-term cyclical
fatigue stresses.
Compressive strength - brittle and weak in
tension
1/11/2015

ANSI / ADA specification No. 96

24 hour compressive strength of 70 Mpa

Strength is strongly and almost linearly

dependent on the powder liquid ratio.

1/11/2015

Water sorption:
affect the mechanical properties
Resin cements
resultant expansion -beneficial
polymerization shrinkage
Film thickness-determines the adaptation of
the restoration to the tooth
ANSI/ ADA Specification No.96
not be greater than 25m
1/11/2015

Viscosity:
-The consistency of the cement can be
qualified
Increase in temperature , time or both
Setting time

1/11/2015

Esthetic properties
Color stability enhancing esthetics
Radiopacity: radiopaque
distinguish between a cement line
and recurrent caries
detect cement overhangs.

1/11/2015

Bonding mechanism
Nonadhesive luting
No adhesion - molecular level
engaging small irregularities.
primary function fluid
fill the gap
Zinc phosphate cement

1/11/2015

Micromechanical bonding:
Deep irregularities -enamel
phosphoric acid solution or gel
hydrofluoric acid on ceramic
chemical etching , electrolytic etching sand
blasting on metals
Resin cement

1/11/2015

Molecular adhesion:
physical -van der waals , bipolar
weak chemical -ionic, covalent
Polycarboxylate cement, glass ionomer depend on nearly parallel walls of the
preparation

1/11/2015

Classification
Water based dental cements
Glass and Resin modified Glass Ionomer
Cement
Zinc Polycarboxylate cement, Zinc phosphate
cement
Resin based dental cements
Composites and adhesive cement, Compomers
Oil based dental cements
Zinc oxide eugenol , Noneugenol- zinc oxide
1/11/2015

Comparison of available luting agents

1/11/2015

Zinc Phosphate Cement

Introduced in 1878 oldest luting cements in dentistry

Mode of supply
Powder and liquid system
ADA / ANSI specification No. 8
classified into two types
Type I : Fine grained for luting
Film thickness -25m or less
Type II: Medium grained for restoration
Film thickness - more than 40m
1/11/2015

 Composition:
Powder
Zinc oxide (90%) main ingredient
Magnesium oxide (8.2 %)- principal modifier
Silicon dioxide, bismuth tri oxide - improves the smoothness of the mix.

Liquid
Phosphoric acid (free acid) - 38.2%
Zinc (0-9%) -moderator of reaction provides adequate working time
Water- 36% -controls ionization which in turn control the rate of the reaction
Aluminum phosphate 2-3% - buffers to reduce the rate of the reaction

1/11/2015

Indication

Metal inlays and onlays

Metal ceramic crown

Cast post and core

Advantages

Adequate film thickness

Excellent flow

Dimensionally stable,no expansion/shrinkage

Disadvantages

Solublity in oral fluids

Poor tensile strength

Easily get abraded & no chemical bond

Potential for pulpal irritation

1/11/2015

Setting time
moderate setting time
5 to 9 minutes
as per ADA specification No. 8 at 37oC

1/11/2015

Factors affecting the setting time under the control

of the operator
Powder to liquid ratio not acceptable
Rate of powder incorporation
Spatulation time
Temperature of the working slab- most effective
way
frozen slab technique (18C to 24C)- extend
the setting time

1/11/2015

Properties
compressive strength of 104 MPa and a
tensile strength of 5.5 MPa
ADA / ANSI specification No. 8 minimum
compressive strength of 75 MPa.
Maximum compressive strength -slab
temperature is between+4C and +8C
(refrigerator temperature) powder to liquid
ratio of -2.8mg /ml and above

1/11/2015

Maximum solubility and disintegration

less than 0.2%(ADA) 24 hours
0.06%
Thermal insulators -good
Chemical bond with enamel and dentin -nil
pH- quite high(3.5) -3 minutes after starting of
mixing
neutral in 24 -48 hours
film thickness -not greater than 25m

Armamentarium

Powder liquid ratio : 2.5 to 3.5 g per 1 ml

1/11/2015

 The field -cotton rolls or saliva ejector for

upper arch
or svedopter for mandibular
Partial protection -two thin layers of copal
cavity varnish.

1/11/2015

 Cool mixing slab temp not below dew point

Powder is placed on end of the slab
At the center of the slab-6 drops of liquid per
unit to be cemented
Divide the powder small increments 3mm size
cement spatula

1/11/2015

 Increment spatulated
approx 20 s
Adding small increments
approx 10 to 20 seconds
Consistency- string out
about 10mm between
the spatula and glass slab
before it runs back onto
the slab.
1/11/2015

 quickly loaded -clean dry restoration.

Brush or wipe cement on the inner surface of
the restoration.
retentive features such as grooves, box forms,
apply some cement directly on the preparation
with a plastic applicator

1/11/2015

 Seat the restoration on the tooth

posterior tooth with uniform occlusion apply
force on the occlusal surface of the restoration
by closing on a plastic wafer
anterior tooth -finger padded by a cotton roll

1/11/2015

 Check that the restoration seated - palpating a

supragingival margin
explorer
field dry until the cement hardens after
seating
Remove the excess cement with a scaler,
explorer or dental floss- irrinant

1/11/2015

Commercial names:

Confit

Harward

Flecks extra ordinary Mizzy

Hy Bond Shofu Dental

1/11/2015

Zinc Polcarboxylate Cement

Introduced by Smith in1968
adhere to tooth
Mode of supply
Powder and liquid system
Powder that is mixed with water
Capsulated powder liquid system for mixing
in a mechanical mixer
1/11/2015

Composition:
Powder
Zinc oxide (90%) main ingredient
Magnesium oxide (8.2 %) - principal
modifier
Liquid
High molecular weight polyacrylic acid
having a molecular weight of 25,000 to50,000
1/11/2015

INDICATION
Cast crown , metal ceramic crown, partial FPD
Casting in a patient with history of post
treatment sensitivity

1/11/2015

Contraindication
Crown and partial FPD with poor retention
Ceramic crowns , inlays, veneers
Resin retained partial FPD
Cast post and core

1/11/2015

Setting time
7 to 9 minutes as per ADA specification No.
96 at 37oC
Factors affecting the setting time
Lowering the temperature
-increase the working time
thicken poly acrylic acid.

1/11/2015

Properties
Compressive strength of 55MP i.e. 1 /2 -2/3 of
zinc phosphate cement
Tensile strength(6.2 MPa)
Maximum solubility and disintegration at 24
hours -0.12% to 0.25 %.
solubility - low when exposed to organic acid
with a pH of 4.5 or less
Thermal insulators: good

1/11/2015

 Bonding with enamel and dentin:

enamel is 3.4 to 13 Mpa
dentin is 2.1 MPa.
Optimum bonding -clean tooth surface
Interfacial adhesive failure -metal cement
interface.
pH of the cement liquid : approx 1.7.
rapidly neutralized by the powder as the
reaction
proceeds.
Film thickness - 25 48 m
1/11/2015

Manipulation:
Armamentarium
Zinc Polycarboxylate cement
liquid with dispenser
Zinc Polycarboxylate cement powder
Powder scoop
Glass slab/ impervious paper
Cement spatula
Powder: liquid ratio : 1.5 parts of powder to 1
part of liquid
1/11/2015

 Isolate the quadrant -cotton rolls.

Tooth -cleaned and drying with the help of
blotting to prevent excess drying.
Sand blast -attain maximum retention
Dispense the powder into a glass slab or a
special impermeable mixing pad -1.5 parts of
powder to 1 part of liquid

1/11/2015

 Liquid dispensed immeriatly before mixing as it

looses The loose of water -increase in viscosity
Powder is incorporated rapidly in large
quantities into the liquid and mixing should be
complete within 30 seconds

1/11/2015

 Coat the inside of the restoration ,tooth

surface: glossy Dull it not allow proper setting
of the restoration
Place the casting -firm finger pressure
Instruct the patient to bite on a plastic wafer or
wooden stick

1/11/2015

 Remove the excess of the cement before the

cement has entered the rubbery stage or after
the cement has completely set.
Keep the restored tooth in a dry environment
until it has completely set.

1/11/2015

Commercial names
Durelon Calibrated- 3M ESPE
Hy bond - Shofu Dental
Tyluk plus Polycarboxylate cement
Encapsulated poly carboxlate Duralon
(3M- ESPE)

1/11/2015

LUTING CEMENTS - II

Glass ionomer Cement

Alan Wilson and Brian Kent in 1960.

Originally ASPA(aluminosilicate poly acrylic

acid)
The International Standards Organization
glass polyalkenoate cement
1/11/2015

Mode of supply
Powder and liquid system
Capsules of preproportioned powder and
liquid
Light cured system

1/11/2015

1/11/2015

Classification
Type I: Luting
Film thickness -25m or less
Type II: Restoration
Type III: Liner or Base
- particle size,
P:L ratio

Composition
Powder :calcium fluro-alumino silicate glass
Silica
- 41.9 to 35.2 %
Alumina
-28.6 to 20.1 %
Aluminum fluoride
-1.6 to 2.4 %
Calcium fluoride
- 15.7 to 20.1 %
Sodium fluoride
-9.3 to 3.6 %
Aluminum phosphate - 3.8 to 12.0%

1/11/2015

Liquid
Originally aqueous solution of poly acrylic acid -50
%. -quite viscous - tendency to gel
Polyacrylic acid - copolymer with itaconic acid,
maleic
acid and tri carboxylic acid
Water
reaction medium
hydrates the reaction products
Tartaric acid improves the handling
characteristics
increases the working time
shorten & sharpen the setting
time
1/11/2015

Indications
Cast crowns , metal ceramic crowns
Multiple cast crown with ceramic margin
Cast post and core
Contraindications
Crown or partial FPD with poor retention
Pressed , high leucite, ceramic crown, inlays,
veneers
Resin retained partial FPD

1/11/2015

Setting time
maximum setting time of 7 .5 minutes
minimum working time of 2 minutes at 37oC
-ADA specification No. 66
extended -9 minutes cool slab of approx
60C

1/11/2015

Properties
Compressive strength -65 Mpa ADA / ANSI
specification No. 61
exhibits -90 to 230 MPa.
improves more rapidly -isolated from
moisture
during its early life.
Solubility -0.4 -1.5% in the first 24 hours.
Thermal insulators - good- galvanic effects
Film thickness -22 to 24m
1/11/2015

 Tensile bond strength

-1 to 3 Mpa GIC and dentin.
lower than of zinc Poly carboxylate cement
sensitivity to moisture
- improve -dentin -acidic conditioner followed
-dilute aqueous solution of ferric chloride
Anti cariogenic properties -rate > silicate
cement
Hypersensitivity -mild to severe
1/11/2015

Manipulation:
The armamentarium
Glass ionomer cement liquid with dispenser
Glass ionomer cement powder
Powder scoop
Treated paper pad or glass slab
Agate or plastic spatula
Powder liquid ratio : 1.3 to 1.35 :1
1/11/2015

 Isolate the quadrant -cotton rolls

saliva ejector or svedopter
rubber dam
Complete isolation -essential

1/11/2015

Teeth conditioned with poly

acrylic acid

Spatulate 25 s , string 2-3 cm

from the slab

Apply cement inside crown,

paint on margins- particular

1/11/2015

Paint a small
qua on the
tooth

Seat crown with

positive pressure

1/11/2015

No indentation with
a sharp instrument

Remove debris from

crevice with floss

Extended protection -margins

varnish, or petrolatum
1/11/2015

Commercial names
Fuji I GC Corporation
Ketac Cem Maxi cap -3M ESPE
Fuji plus capsule- G C Corporation
Rely X luting cement -3M ESPE
Ketac-Cem-GIC

1/11/2015

Resin Modified Glass Ionomer Cement (Hybrid

Ionomer)

Light activated
Chemically activated
Dual cured
Mode of supply
Powder liquid system
Paste paste system
Encapsulated unit dose ampoules
1/11/2015

Composition
Powder in a typical light cured system
Ion-leachable glass
Initiators for light or chemical or both

Liquid

1/11/2015

Poly acrylic acid reacts with glass

Water- ionization of the acid -base reaction
Methyl methacrylate polymerization of resin
Hydroxyl ethyl methacrylate(HEMA)- acid and
resin matrix -coexist , polymerization

Properties
Compressive strength and tensile strength similar GIC.
Solubility- low
Bond strength of 10 to14 MPa -moist dentin
highest in water based cement
enamel ,dentin -micro mechanical
interlocking
1/11/2015

Anti cariogenic properties- GIC

Minimal hypersensitivity
Water sorption - higher than in resin cement
Film thickness -10 -22 m
Setting reaction -2 mechanisms
acid base reaction
light or self cured polymerization
reaction of pendant methacrylate groups

1/11/2015

Manipulation:
Armamentarium
Resin modified Glass ionomer cement liquid
with dispenser
Resin modified Glass ionomer cement powder
Powder scoop
Treated paper pad, glass slab
Agate or plastic spatula

1/11/2015

 Isolated -cotton rolls

Powder is fluffed before dispensing

Liquid is dispensed by keeping the vial vertical
to the mixing pad
P:L ratio 1.6 g of powder to 1g of liquid
1/11/2015

 Powder is incorporated- liquid -30 s mousse

consistency
The mix - clean dry tooth
Seated with finger pressure ,and the excess of
the cement is removed after initial setting
time of 1.5 to2 minutes.
1/11/2015

Comercial names
Advance- Dentsply
Fuji Duet GC
Vitermer luting cement 3M

1/11/2015

RESIN BASED CEMENT

-

1952
1986- direct filled resin,
reduce fracture of the ceramic structure
range of shade available to produce optimal
aesthetic appearance.
- differ from restorative composites -lower filler
content and lower viscosity

1/11/2015

Mode of supply
Powder liquid system
Self cured
Dual cured two paste system- hand or auto
mixed systems
Clicker Dispenser

1/11/2015

Indication
Crowns ,bridges- etched cast restoration and
inlays -DC,SC
Porcelain veneer-LC, DC,SC
Resin bounded bridges- DC,SC
Cast post and core
Contraindication
Casting on patient with post -treatment
sensitivity
1/11/2015

Composition:
Resin matrix (diacrylate monomer)
Fillers (glass and silica) - 10 -15 m
Coupling agent (organo silane)
Organophoshosphates, hydoxy ethyl
methacrylate (HEMA), 4methyacrylethyltrimellitic anhydrate (4
META) used to facilitate bonding to dentin
Conventional peroxide-amide induction system
or light activating system

1/11/2015

Properties
Compressive strength of 180 -265 MPa ,
tensile strength of 34 -37 MPa
Insoluble in oral fluids, with a solubility of
0.13% in 24 hours
Thermal insulators - reducing galvanic effects
Reasonably good bonding strength
enamel, dentin- micromechanical
acid etched surface

1/11/2015

Irritant to the pulp - dentin <0.5 mm

- GIC liner, Ca(OH)2
Film thickness - >25 m
Setting time
- 4 to 5 minutes approx

1/11/2015

Manipulation
Auto polymerized resin -thickness of the
restoration is
> 2.5 mm.
Isolation-using cotton roll isolation
rubber dam - superior results

Material and the mixing dish refrigerator

Ceramic etch hydro fluoric acid and
1/11/2015

Air abrade - castcrown -50m Al 2 O3 80psi or

more.
Rinse and dry -compressed air
Tooth surface -pumice

wash

1/11/2015

&

dry

Etch enamel -30 seconds with enamel

etchant, Rinse and dry the tooth
Dentin activator - 10 s, rinse and dry
lightly. Do not desiccate

Mix base and the catalyst -ceramic

mixing well -manufactures
recommendation- creamy consistency.

1/11/2015

Paint the tooth and the inside surface of the

restoration with the mixture

If the restoration is too big -wet the surface of

the restoration with more liquid
Seat the restoration quickly - less working
time, long setting time -10 minutes

1/11/2015

Wipe off the excess -soft -cotton pellet

wetted with a drop of base liquid. Do not
remove the excess -rubbery

Remove the excess cement with the help of a

scaler
1/11/2015

Light cured single component system

Indications
Thin ceramic prosthesis <1.5mm.
Resin based prosthesis
Direct bonding prosthesis <1.5mm
The time -intensity of the light

1/11/2015

Dual cured resin cement

-similar to auto polymerized resin cement
Chemical activation -slow ,extended working
time until the cement is exposed to light
Curing light -cement hardens rapidly
Continuous to gain strength due to continued
curing due to chemical activation
- Recommended for inlays and onlays

1/11/2015

Cementation of provisional restoration

paste paste system
dual cured
light cured
Esthetic zones -esthetic
Fluoride
No eugenol impair polymerization of resin
Easy to clean
low compressive strength -(25-70 MPa)

1/11/2015

Commercial names
Auto polymerizing
1. All-bond C&B luting
2. Biomer
Dual cure
1. Dicor LAC
2. En Force with Flouride
1/11/2015

Temporary cement
TempBond Clear
Veneers
Rely X Veneer Cement -3M ESPE

1/11/2015

Compomer
poly acid modified monomers with fluoridereleasing silicate glasses -formulated without
water.
Indicated -cast alloy crowns and bridges
cast gold inlays
ceramic-metal crowns
Mode of supply
Powder and liquid system
Two paste system
1/11/2015

Powder
Strontium aluminum fluorosilicate glass
Metallic oxide
Chemical or light activated initiators
Liquid
Polymerized methacrylate or carboxylic
acid monomer
Multifunctional acrylate or phosphate
monomer
Diacrylate monomer
Water
1/11/2015

Properties
Compressive strength -100 MPa
Insoluble in oral fluids
Thermal Insulators -reducing galvanic effects
Bond strength of 18 -24 MPa similar GIC
Acidity 3 min after starting of mixing pH -(3.5)
neutrality in 24 -48 hours
Fluoride released <GIC

1/11/2015

 Manipulation
The two paste system ~ powder and liquid
system,
The tooth surface -etchant. Clean -dry with
out desiccating the surface of the tooth

Dentin bonding agent is applied

Mix the pow and liq rapidly for 30 s
The mixed cement -restoration and seated finger pressure
1/11/2015

A gel form -1 minute

excess cement is removed with a floss and a
scaler

Margins -light cured immediately to stabilize

the prosthesis.
Chemical curing is completed 3 minutes after
the start of the mix
1/11/2015

Commercial names
Dyract Cem- two paste system
Principal -Dentsply

1/11/2015

OIL BASED CEMENTS

Zinc oxide eugenol cement and non eugenol
cement
since 1890s
Poor strength
Sedative- dentin
Mode of supply
Powder and liquid system
Two paste system
1/11/2015

Composition:
Powder
Zinc oxide (69%) main ingredient
White rosin (29.3%) - reduce the brittleness
Zinc acetate (0.7%) improve the strength
Zinc stearate (1%) plasticizer
Liquid
Eugenol (85%) main ingredient
Olive oil (15%) - plasticizer
1/11/2015

Ortho ethoxy benzoic acid (EBA) -liquid and

alumina -powder
Methyl methacrylate powder -powder to 20 40 wt% zinc oxide is treated with carboxylic
acid and eugenol constitute the liquid.

Eugenol -interfere - resin bound composites

carboxylic acid -zinc oxide- non eugenol cement.

1/11/2015

Classification
ADA / ANSI specification No. 30
Type I : Temporary cementation
Type II: Long term cementation
Type III: Temporary filling and thermal
insulating base
Type IV : Cavity liners
1/11/2015

Type I
Low strength removal without trauma to the
tooth and damage to the restoration.
seals -against ingest of oral fluids for a short
duration.
Compressive strength - 35 Mpa -24 hrs
Max disintegration - 2.5% - 24 hrs
Type II
Max disintegration -24 hours -1.5 %
1/11/2015

Setting time
4-10 minutes , at 370C and 100% humidity

Powder : Liquid
Temperature of the working slab : most
effective
way
Cooling of the slab above the dew point
:slows the
rate of the reaction
Below the dew point
:increased

1/11/2015

Properties
Compressive strength -3-55 MPa.
The smaller -size of the powder stronger
Maximum solubility and disintegration at 24
hrs -2.5%. less critical -provisional restoration
A maximum value of 2.5% -provisional cement
1.5% -permanent cement
1/11/2015

 Chemical bond- no enamel and dentin

Least irritating -the pH is approx 7 at the time

of placement
Film thickness -not >25m -permanent
cementation
not >40m -temporary
cementation
1/11/2015

Manipulation
Unmodified and non eugenol Zinc oxide
cements -two paste system. Equal length uniform colour.

Temporary Cementation suitable consistency

more the powder -stronger ,viscous the
mixed cement.
1/11/2015

Commercial names
Embonte temporary cement
Zone temporary cement
Temp-Bond

1/11/2015

CEMENT SELECTION
No ideal luting agent
Adhesive techniques - expand services, and
many procedures cannot be provided with
traditional water-based luting agents.
Several materials -comprehensive patient
care, some materials are contraindicated for
certain techniques, the best choice is not
always clear.
1/11/2015

PROCEDURE OF CEMENTATION OF PROSTHESIS

Coat the entire inner surface , slightly

extend over the margins of the restoration space between the tooth and the restoration
is completely sealed.
Cement layer in the occlusal aspect - free of
voids.

1/11/2015

Complete filling of the inner aspect of the

restoration - not advisable
Risk of bubble entrapment
Increased time of seating
Increased pressure may be required to seat
the restoration
Time for removal of the restoration is
increased

1/11/2015

Cement failure
fatigue failure
The following factors influence cement failure
Abutment taper
Resistance form
Preparation height and diameter

1/11/2015

Conclusion

1/11/2015

References
Craigs Restorative dental materials-12th edition- John
.M. Powers
Phillips Textbook of dental materials- 11th editionAnusavice
Fundamentals of fixed Prosthodontics- 3rd editionShillinburg
Contemporary fixed Prosthodontics- 4th editionRosenstiel
Dental materials- OBrein
Dental cements for definitive luting : A review and
practical clinical consideration-Dent Clin N Am
51(2007) 643- 658
1/11/2015

Thank you

..CONTD

1/11/2015