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Luting agents and cementation techniques

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 FFaculty of Dentistry
Crown & Bridges Department

Student name : ‫محمود شحاته سعيد جادهللا‬

Student number : 3139
Group : D
Search topic : Luting agents and cementation techniques
 Introduction
luting agent term defined as : an application of a dental cement connecting the
underlying tooth structure to a fixed prosthesis.
Dental cements are widely used in dental procedures as temporary restorations ,
cavity linings for pulp protection, sedation or insulation purpose and cementation
of fixed prosthodontic appliances.
Traditional cements are applied as powder and liquid components which are
manually mixed to form a viscous mix ,this mix sets to form a brittle solid after
application on the treated surface.
More advanced cements, such as GIC, can come in capsules and are mechanically
mixed using rotating or amalgamator.[1]
Decision-making in the selection of the suitable dental cement has become more
difficult than ever before. The focus of this research is to provide a brief
understanding of the properties and classifications of cements and the factors
that determine the best selection of cement to enhance the success and longevity
of the restoration ..

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1-Ideal requirements of luting agents
• Non irritant: – many cements are acidic and irritate the pulp.
• Provide a good marginal seal to prevent marginal leakage.
• Resistant to dissolution in oral fluids
• High mechanical properties .
• Adequate working and setting time.
• Good aesthetics.
• Good thermal and chemical resistance.
• Opacity – for diagnostic purposes on X_rays.
• Low film thickness (ideally 25 microns).
• Retention .[2]
2-Classification of cements
a-According to duration of application
֍Definitive cements(permanent):
1-Zinc phosphate:
•Advantages : •Disadvantages
Highest elastic modulus Acidic : pulpal irritant
High Compressive Strength Low tensile strength
Low film thickness Provides only mechanical seal
Low cost Exothermic during set
Long working time High solubility in oral fluids

•indications :
Zinc phosphate is used to place restorations which are depend on mechanical
retention mainly and restorations that need long working time as long span
bridges such as Long span bridges ,Metal Crowns , Metal-Ceramic
Crowns,Feldspathic and Porcelain jacket crowns.[3,4]
•contraindications: With all-ceramic restorations because using zinc phosphate in
luting ceramic crowns may result in decreased aesthetic properties .

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2-Zinc polycarboxylate:
•Advantages : •Disadvantages
Antibacterial Low resistance to erosion in acidic
Low irritation environment
Chemical adhesive to tooth structure Short working time
Sufficient compressive strength
Higher tensile strength than Zinc Phosphate
•indications : Porcelain restorations, Metal crowns, Metal-ceramic crowns
Zinc polycarboxylate bonds well with stainless steel, and this makes it useful for
the attachment of orthodontic bands.[3,4,5]
•contraindications:
with porcelain crowns due to zinc polycarboxylate is opaque .
3-Glass ionomer:
•Advantages : •Disadvantages
Chemical adhere to tooth structure Rapid set – time limitation especially in
Fluoride release cementation of several units.
Good Aesthetic due to its Translucency Moisture sensitivity at set
Thermal compatible with enamel Possible pulpal sensitivity
Good resistance to acid dissolution
•indications:
Metal and Metal-Ceramic Restorations
Porcelain restorations
All Ceramic Crowns with high strength cores such as alumina or zirconia
•contraindications:
contraindicated for all-ceramic restorations that are low-strength.[3,6]

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4-Resin modified glass ionomer:
•Advantages : •Disadvantages
Dual cure Setting expansion may lead to cracking of all-
Fluoride release ceramic crowns
Higher flexural strength than GI Moisture sensitive
Capable of bonding to composite materials
•indications:
for both metal and metal ceramic restorations
•contraindications:
*All-ceramic crowns – due to uptake of water causing swelling and pressure on
the crown and may cause cracks (hygroscopic expansion)
*Veneer – not retentive enough
*tooth preparations with poor retention and resistance forms.[5,6]
5-Resin:
•Advantages : •Disadvantages
Strongest of the cement – highest tensile Polymerization shrinkage leading to marginal
strength. leakage
Least soluble (in oral fluids) Difficult sealing
High micromechanical bonding Possible pulpal sensitivity
Neutral pH Difficult to remove excess cement

•indications:
*Resin cements are widely selected for luting non-metallic restorations, resin
bonded bridges, ceramic crowns and porcelain veneers .
•contraindications:
Light cured type under a metalic crown since light would pass through the metal.

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֍Provisional cements(Temporary)
Temporaryluting agents are used for inter-appointment fixation of temporary
restorations, or cementation of a permanent restoration for patient feedback .
As these temporary restorations will be removed, it should be poor physical and
mechanical properties, such as low tensile strength and high solubility; as well as
no pulp irritability and easy handling The main temporary luting agents include:
1-Zinc oxide-eugenol:
•Advantages : •Disadvantages
Neutral pH making an Obtundent effect on If used as permanent :
pulpal tissues Weakest of the cements
If used as temporary : Low strength
Low strength Low abrasion resistance
Low abrasion resistance Soluble (in oral fluids)
Little anticariogenic action

•indications:
* Temporary crowns, bridges ,Provisional cementation of fixed partial dentures .
•contraindications: permanent cementation.[6]

5|Page Figure 1:Summary of clinical applications of different types of cements.[7]

b-According to setting reaction:
Acid-base reaction
*zinc phosphate
*zinc polycarboxylate
*zinc oxide and eugenol
*glass-ionomer.[8]

Polymerization reaction
*resin-modified glass-ionomer cement (RMGIC)
*resin cement.[8]

3-Means of bonding to tooth structure

1-True adhesion : it is a chemical bonds between the materials being joined due
to chemical reaction .
2-Micromechanical bonding : bonding using surface irregularities or micro pores
of the surface making micro mechanical interlocking leading to strong bond .
3-Macromechanical bonding : mechanical interlocking between tow objects on
the macro scale .[9]

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4-cementation techniques & Bonding
a-for acid-base cements
1-zinc phosphate & zinc oxide-eugenol: these cements are mechanically bonded
to tooth structures through interlocking into irregularities on the tooth surface
and fitting surface of the crown that is done by sand-blasting.
2-zinc polycarboxylate & glass-ionomer: they have cooH group that bond
chemically to tooth structure .[9]
b-for resin cements : there is three bonding techniques :-
1-Total-etching system :
With etch-and-rinse systems, dentin and enamel are treated with phosphoric acid
to remove the smear layer and demineralize the superficial dentin layer. After
acid etching, a mixture of resin monomers plus an organic solvent is applied to
penetrate the etched dentin and create a bonding interface.[9]
2-self-etching system :
Self-etch systems do not require a separate etching step, because they contain
acidic functional monomers that simultaneously etch and prime the tooth
substrate for bonding. The self-etch system is purported to be user-friendly and
less technique-sensitive, thereby resulting in reliable clinical performance.[9]
3-self adhesive system:
Some functional monomers in self-etch adhesives can quickly chemically interact
with hydroxyapatite and directly applied to the fitting surface which results in
weak bond than previous two systems .[9],figure 2 .[9]

Figure

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5-cementation procedures
1) Trial Fit of Crown (“Try-In”).[10]
a) Extra-oral assessment : of The delivered crown on the working die and model.
b) Intra-oral assessment : the crown will be assessed intra-orally to ensure that
the crown remains completely seated on the tooth and there is a proper proximal
and occlusal contacts .
2) Cementation Process .[10]
*During cementation a layer of the chosen cement is placed inside the casting and
the crown is seated firmly on the tooth and retracted to the margins to make a
scape way .
*The luting cement fills the microscopic gap, seals the margin and secures the
crown.
*Isolation from saliva during the luting process is essential, using a saliva ejector
on the floor of the mouth and appropriately placed cotton wool rolls.
*All cements should be mixed according to the manufacturer’s directions to
provide a smooth mix and used without delay.
*Avoid Delaying use to prevent early initiation of the setting process causing
reduced cement flow, incomplete seating, increased thickness of the marginal
cement line and crown elevation requiring occlusal adjustment.
*The crown should be coated evenly with cement over the internal surface
avoiding trapping air bubbles and be no more than half filled. The crown is
immediately seated firmly on the clean, isolated and dry tooth providing
significant force and steady pressure to express the excess cement and ensure
complete seating.
*The marginal adaptation should be quickly checked at this point with an explorer
and firm pressure maintained until the cement has set.
*after cement setting , the excess cement is fractured away from the margins
.[10]

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 Rrsferences
1-Bonsor, Stephen J., and Gavin Pearson. A clinical guide to applied dental
materials. Elsevier Health Sciences, 2012.
2-Ferracane, Jack, Luiz E. Bertassoni, and Carmem S. Pfeifer. Dental Biomaterials,
An Issue of Dental Clinics of North America, E-Book. Vol. 61. No. 4. Elsevier Health
Sciences, 2017.
3-Banerji, Subir, and Shamir B. Mehta. "Adhesive Dentistry." Practical Procedures
in Aesthetic Dentistry (2017): 109.
4-Yu, Hao, et al. "Proper selection of contemporary dental cements." Oral Health
Dent Manag 13.1 (2014): 54-59.
5-EE Hill; J Lott (2011). A clinically focused discussion of luting materials. ,
56(Supplement s1), 67–76.
6-Komal Ladha; Mahesh Verma (2010). Conventional and Contemporary Luting
Cements: An Overview.
7-https://en.wikipedia.org/wiki/Luting_agent#cite_note-Hill_2011-38
8-Lad, Pritam P., et al. "Practical clinical considerations of luting cements: A
review." Journal of international oral health: JIOH 6.1 (2014): 116.
9-Miyazaki, Masashi; Tsujimoto, Akimasa; Tsubota, Keishi; Takamizawa, Toshiki;
Kurokawa, Hiroyasu; A. Platt, Jeffrey (2014). Important compositional
characteristics in the clinical use of adhesive systems. Journal of Oral Science,
56(1), 1–9.
10-https://iits.dentistry.utoronto.ca/crown-cementation

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