Dental cements

DENTAL CEMENTS
PRESENTED BY –
Dr. Prajakta .B. Gir.
1st year PG
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CONTENTS
• INTRODUCTION
• HISTORY
• TERMINOLOGIES
• CLASSIFICATION
• IDEAL PROPERTIES OF DENTAL CEMENTS
• RESTORATIVE CEMENTS
• LUTING CEMENTS
• AGENTS FOR PULP PROTECTION
• ZINC PHOSPHATE CEMENT 2

• SILICATE CEMENT
• ZINC SILICOPHOSPHATE CEMENT
• ZINC POLYCARBOXYLATE CEMENT
• ZINC OXIDE EUGENOL CEMENT
• GLASS IONOMER CEMENT
• RESIN CEMENTS
• CALCIUM HYDROXIDE
• FLUORIDES IN DENTAL MATERIALS
• SOLUBILITY AND DISINTEGRATION OF CEMENTS
• SUMMARY
• REVIEW OF LITERATURE
• REFERENCES
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In Dentistry, the term “cement” has been applied, traditionally to powder /
liquid materials which are mixed to a paste consistency ,set to a hardness, and
used clinically to restore teeth and attach preformed restorations, in or on the
teeth.
Dental cements, in the recent years has become restricted to those materials
which are employed to bond inlays, crowns, bridges, posts and facings in or on
the tooth and to retain orthodontic bands and retainers, however secondary
applications of these cements include cavity linings, bases and temporary
fillings.
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These different applications make varying demands on manipulative
properties, working and setting time, and resistance to mechanical breakdown
and dissolution.
Thus some materials are better suited to some application than others.
Many of these materials are supplied in powder/liquid form and set by an acid-
base reaction, but this is not universally true.
The word `cement’ as used in this context, conveys the idea not only of a
bonding agent but also the concept implied in the word ‘lute’ that is , the
additional requirement of gap filling and sealing.
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HISTORY
• 1871 - Silicate cement by Fletcher
• 1879 - Zinc phosphate cement by Dr Pierce
• 1920 - Calcium hydroxide paste by Hermann
• 1875 – Zinc Oxide Eugenol by Dr. D.J Foster Flagg
• 1968 - Zinc Polycarboxilic cement by Dennis Smith
• 1960 – Composites by R.L Bowen
• 1947 - Methyl methacrylate resins
• 1971 - Glass ionomer cement by Wilson and Kent
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• 1981 - Adhesive Resin Cement
• 1963 – Aromatic Dimethacrylate – Based Resin Cement by Dr. Rafael
Bowen
• 1993 – Compomers
• 1990 – Resin Modified Glass- Ionomer Cements
• 1878 – Zinc Silicophosphate Cement

DEFINITION
Cement is defined as a ‘substance that hardens to act as a base, liner, filling
material or adhesive to bind devices and prosthesis to tooth structure or to each
other’ .
-Kenneth j. Anusavice
A cement is commonly considered as a ‘substance that holds two surfaces
together, it also serves as an agent as esthetic restorative material, thermal
insulator, temporary restorative material and medicament for pulpal protection
under larger restoration
-Karl. F. and Jack Moons
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Cement is a ‘non metallic material used for luting, filling permanent or
temporary restorative purposes, made by mixing components into a plastic
mass that sets or as an adherent sealer in attaching various dental restorations
in or on the tooth’.
-CRAIG
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ACCORDING TO SETTING REACTION
- ANUSAVICE
- E.C. COOMBE
ACCORDING TO MATRIX FORMING
- O’BRIEN
ACCORDING TO ADA
ACCORDING TO DONOVON
ACCORDING TO MECHANISM OF LUTING
-ROSENSTIEL
ACCORDING TO CHIEF CHEMICAL
INGREDIENT
- CRAIG
CLASSIFICATION
ACCORDING TO USES
- SKINNER

BASED ON INGREDIENTS :
- CRAIG
WATER BASED
Glass & Resin Modified Glass Ionomer , Zinc Polycarboxylate , Zinc
Phosphate
OIL BASED
Zinc oxide eugenol , Non-eugenol Zinc oxide
RESIN BASED
Composite and Adhesive Resins , Compomer Dental Cements
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BASED ON MATRIX TYPE:
- O’BRIEN
PHOSPHATE
Zinc Phosphate
Zinc Silico phosphate
PHENOLATE
Zinc oxide eugenol
Calcium Hydroxide Salicylate
POLYCARBOXYLATE
Zinc Polycarboxylate Glass Ionomer
RESIN
Polymethyl Methacrylate
Dimethyl Methacrylate Adhesive
RESIN MODIFIED GLASS
IONOMER
Hybrid Ionomer Dental Cements
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BASED ON SETTING REACTION :
- KENNETH .J. ANUSAVICE
• ACID BASE REACTION : - Zinc Phosphate cement
- Zinc polycarboxylate cement
- Zinc oxide- eugenol cement
- Glass ionomer cement
• LIGHT / CHEMICAL : - activated polymerization and acid base reaction
• RESIN MODIFIED GLASS IONOMER CEMENT : - Compomers
- Resin cement
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ACCORDING TO SETTING REACTION :
- E.C COOMBE
ACID BASE
REACTIONS
Zinc phosphate, Zinc polycarboxylate ,Zinc oxide
eugenol Silicate ,Glass ionomer cement
POLYMERISING
MATERIALS
Acrylic polymer ,Cyanoacrylates, Dimethacrylate
polymers, Polymer ceramic composites
OTHER MATERIALS Calcium hydroxide ,Guttapercha , Varnishes.
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ACCORDING TO ADA SPECIFICATION :
Type I Fine grain for cementation, luting Type
Type II Medium grain for bases, orthodontic purpose
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ACCORDING TO DONOVON :
Conventional Cements Zinc Phosphate, Zinc oxide eugenol, Zinc
polycarboxylate, Glass Ionomers
Contemporary Cements Resin Modified GIC, Resin Cements
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ACCORDING TO LUTING MECHANISM:
- ROSENSTIEL
NON –ADHESIVE LUTING Zinc phosphate
Zoe
MICROMECHANICAL BONDING Resin cements
MOLECULAR ADHESION Polycarboxylates
GiC
Resin modified gic
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ACCORDING TO USES :
- SKINNER’S
MATERIALS PRIMARY USES SECONDARY USES
1. ZnOE I
ZnOE II
ZnOE III
ZnOE IV
Temp. cementation
Permanent cementation
Temp. filling, base
Lining
Root canal sealing, pulp
capping
Periodontic bandage
Pulp capping
Surgical dressing
2. Ca(OH)2 Pulp capping Weak cement base, cavity
liner
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3. ZnPO4
Luting metallic restoration
and orthodontic bands
Thermal insulating base,
intermediate restorations
root canal treatment
4. ZnPO4 with Ag or
Cu
Intermediate restorations Temporary filling of
deciduous teeth
5. Zinc
polycarboxylate
cement
Luting, bases Cementation of
orthodontic bands,
intermediate restorations,
root canal sealants, lining

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6. Silicate (Not used
now)
Anterior restorations Rampant caries of
deciduous teeth treatment
7. Zn-Si-Phosphate Luting of porcelain
crown or veneers
Intermediate restorations
luting of alloy
fabrications, orthodontic
bands
8. Composite resins Anterior, posterior
restorations
Pit and fissure sealants,
veneers

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9. Glass ionomers (I)
Glass ionomers (II)
Glass ionomers (III)
GIC metal modified,
compomers
Luting
Restoration
Liner, base
Restoration
Restoration of cervical
erosion cavities.
Pit and fissure sealant,
core
build up
Luting orthodontic bands

IDEAL REQUIREMENTS :
1. BIOLOGICAL PROPERTIES:
• Biocompatible
• Bacteriostatic
• Cariostatic and anticariogenic
• Obtundent
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2. CHEMICAL PROPERTIES:
• Chemically inert
• Resistant to tarnish and corrosion
• Resist dissolution and disintegration
• Should not absorb saliva
• Chemically bond to tooth structure
3. RHEOLOGICAL PROPERTIES :
• Low viscosity
• Adequate adjustable working times
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4. MECHANICAL PROPERTIES :
• High proportional limit to resist permanent deformation
• High modulus of elasticity to resist dimensional change
• High compressive strength to resist fracture
• Not brittle
• Abrasive resistance
5. THERMAL PROPERTIES :
• Same COTE as of enamel
• Good insulators
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6. AESTHETIC REQUIREMENTS :
• Transparent or translucent
• Same refractive index as tooth enamel
• Same colour parameters as tooth
• No discolouration
7. OTHER :
• Radio-opaque
• Simple manipulation
• Should not be technique sensitive
• Long storage life
• Less expensive
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RESTORATIVE CEMENTS
Types of restorative cements :
1. Temporary restoratives–lasting for few days to weeks
2. Intermediate restoratives–lasting for few weeks to months
3. Permanent restoratives–lasting for more than five years
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TEMPORARY RESTORATIVE MATERIALS
These are short-term restorations that are planned for a few weeks to allow the
inflamed pulp to heal and are then replaced with a long-term restoration.
Materials used are calcium hydroxide, zinc oxide eugenol (type III)
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INTERMEDIATE RESTORATIVE
MATERIALS
This is placed when the restoration is expected to last for a period of 3–6
months, when the inflamed pulp status is under follow-up or when another
ongoing treatment like orthodontic/ periodontic treatment is being done in the
same tooth.
These materials have higher strength than temporary restoratives.
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Materials used are improved zinc oxide eugenol cements with polymer resin,
or alumina and EBA modifications. Sometimes zinc phosphate cements, zinc
polycarboxylates, glass ionomer cements, zinc silicophosphate cements are
also used.

PERMANENT RESTORATIVE MATERIALS
 These should last theoretically lifetime.
 Materials and methods are selected according to clinical situations, such as
anterior, posterior, metallic, nonmetallic, etc.
 These require very strong, bonding to tooth structures, high strength, etc.
properties.
 Hybrid composites, GIC for nonstress bearing areas are used as nonmetallic
restorations
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LUTING CEMENTS
 Dental cements have been used as a luting agent for retaining (fixing) indirect
restorations such as inlays, onlays, veneers, crowns, and bridges, which have
been fabricated in the laboratory.
 Luting cements can be definitive (long term) or provisional (temporary)
depending on their physical properties and planned longevity of the restoration.
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1) Long-term luting cements: Glass ionomers, hybrid ionomers, zinc
phosphates, zinc polycarboxylates, resin cements, reinforced ZOE
1) Short-term luting cements: ZOE

Schillinburg and colleagues described different
luting mechanisms as follows
1. Non-adhesive: In this, the luting cement fills the restoration–tooth gap and
holds by engaging in small surface irregularities. All luting cements have
this property. Zinc phosphate uses this method of bonding by engaging in an
irregularity in the preparation. Nearly parallel opposing walls of the
preparation allow for adequate retention.
Non adhesive luting cement
extending into irregularities
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2. Micromechanical bonding: In this mechanism, surface irregularities are
enhanced through air abrasion (on the restoration fitting surface) or acid etching
(on the tooth surface) to provide larger irregularities for the luting cement to fill
and improve the frictional retention. This is employed in case of resin cements.
Micromechanical bonding

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3. Molecular bonding: This results from van der Waals forces and a chemical
bond between the cement and tooth surface. Zinc polycarboxylate and GIC
luting cements have molecular bonding with the tooth surface. This should be
looked upon only as a way to enhance mechanical and micromechanical
retention and reduce micro-leakage, rather than an independent bonding
mechanism.
Molecular adhesion

PULP PROTECTING MATERIALS
 Pulpal irritation are caused by:
1. Chemical irritation........ by passage of chemicals from restorative material.
2. Marginal leakage.......... due to poor bonding of restorations–percolation.
3. Thermal sensitivity........ due to passage of heat thermal fluctuations.
4. Galvanic shock/pain..... due to the presence of two dissimilar metals coming
into contact.
5. Trauma........................ accident, biting forces
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 Therefore, pulpal protection requires consideration of chemical, thermal,
electrical protections, mechanical support to overlying restoration and pulpal
medications.
 Thus the cavity liners, varnishes and bases are designed as materials to protect
the pulp against thermal, electrical , chemical and mechanical trauma insults
and must also give mechanical support to above restoration.
 The type of auxiliary material to be used depends upon the minimum
thickness of the dentin left between the pulp floor of the cavity and the dental
pulp. This is known as the remaining dentin thickness (RDT)

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RDT ≥2 mm, solution liner only—to be given on all internal surfaces of the
cavity under metallic restorations, no liner/base for tooth-colored restorations
(such as GIC, composite resins)
RDT <2mm, a base of thickness 0.5–0.75 mm is given on the pulpal floor and
axial wall only.
RDT <1mm, the pulpal floor close to the pulp where the RDT is less than 1
mm is covered with a suspension liner, over which a base is given.

CAVITY LINERS
These are the materials used to coat the walls and floors of the prepared cavity
to protect the underlying dentin and pulp from the chemical and thermal
insults.
 There are two types of cavity lining agents :
• Cavity liners
• Cavity varnishes.
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Ideal requirements of cavity liners :
1. Bacteriostatic
2. Provide electrical and thermal insulation
3. Prevent discolouration of tooth structure
4. Prevent penetration of chemical ions from the restorative materials to dentin
and pulp, i.e. good insulators
5. Prevent marginal leakage at the tooth restoration interface
6. Anticariogenic property
7. Chemical bonding to tooth structure.

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Liners can be classified as follows:
1. Thin film liners (1–50 mm)
a. Solution liners (varnish; 2–5 mm)
b. Suspension liners (zinc oxide [type IV]/ calcium hydroxide; 20– 25 mm)
2. Thick liners (200–1000 mm)
a. GIC (type III)

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Dispensing and composition :
1. Suspension or liquid cavity liner: Suspensions of Ca(OH)2 or zinc oxide
eugenol in organic solvents such as methyl ethyl ketone, ethyl alcohol or an
aqueous solution of ethyl cellulose. Upon evaporation of volatile solvents the
liner forms thin film on the surface of the prepared cavity.
2. Paste cavity liners : 2 paste system (base + reactor)
For example, Ca(OH)2 (dycal), zinc oxide eugenol liner (type 1V)
3. Single paste with solvent:
For example, Ca(OH)2 paste and a solvent, methylcellulose.

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4. Single paste system: Light activated Ca(OH)2 , Dycal .
5. Powder and liquid system: For example, glass ionomer liners (type III and
zinc oxide eugenol liners (type 1V).

CAVITY VARNISHES
These materials are used to provide a barrier against the passage of irritants
from the restorative materials and to reduce the penetration of oral fluids at the
restoration-tooth interface into the pulp.
Composition :
• Consists of a natural gums such as copal resin or rosin or a synthetic resin
(nitrated cellulose) dissolved in organic solvents such as acetone, chloroform
or ether.
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Functions :
1. Reduces the marginal leakage around most restorative materials and specially
for silver amalgam.
2. Protect the pulp from irritation by chemicals in the restorative materials.
3. Blocks the penetration of metallic ions from amalgam restoration to the
adjoining dentin and enamel and reduces tooth discolouration.

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Contraindications :
1. For GICs and silicate cements: Because it prevents the chemical adhesion and
also reduces anticariogenic effects. Solvent supplied can be added for
thinning.
2. Composite resins: Because it inhibits the polymerization mechanism of the
resin and produce softening of the resin.

CAVITY BASES
These are materials applied on the exposed dentin, as a sufficiently thick layer
(0.75 mm–2 mm), to protect the underlying pulp from external insults like
chemical, thermal, electrical and mechanical (such as condensation of amalgam
or biting forces).
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Ideal requirements :
1. They should be bacteriostatic, obtundent, anticariogenic.
2. Promote formation of secondary or reparative dentin
3. Provide electrical, thermal insulation under metallic restoration, i.e. they
should be good insulators
4. Prevent the penetration of harmful chemical ions from the restoration
5. Should have sufficient strength to withstand condensation forces of
amalgam, or biting forces.
6. Thickness of approximately 1.5 mm is needed for effective insulation.

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Bases have been classified as follows:
1. Low strength bases :
a. ZOE, calcium hydroxides
b. Generally used under temporary/interim restorations
c. Calcium hydroxide used as a sub-base
2. High strength bases :
a. GIC, reinforced ZOE, zinc phosphate, zinc polycarboxylate
b. Used under direct and indirect metallic restorations
c. Only some bases are indicated under composite resins, e.g., GI

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 Clinical considerations : The clinician must observe certain general
guidelines for placement of bases:
1. The base should be 0.5–0.75 mm thick. Very thick bases compromise the
bulk of restorations and increase the potential for fracture of the
restoration.
2. It is not recommended to remove sound tooth structure in order to provide
space for a base. Conserving sound tooth structure will enhance restorative
support and provide pulpal protection.
3. Bases are applied only on internal walls of cavity preparation to prevent
dissolution by saliva.

ZINC PHOSPHATE CEMENT
 ADA SPECIFICATION NO. 8
 Zinc phosphate cement is the oldest luting cement introduced way back in
1800s.
 These cements are mainly used as luting cements (type I) as well as thermal
insulating base and intermediate restorative material (type II)
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Alternative names :
• Zinc cement
• Zinc improved cement
• Zinc oxyphosphate cement
• Crown and bridge cement.
Dispensing :
• Dispensed in the form of powder and liquid in separate bottles. It can also be
supplied in the form of capsule with pre-proportioned powder and liquid.

COMPOSITION
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POWDER LIQUID
Zinc oxide: Approximately 90.2% Aqueous solution of phosphoric acid: 50%–
60% (main ingredient) a. Free acid: 38.2%
b. Combined with Zn and Al:
16.2%
Magnesium oxide: 8.2% (reduces temperature
of calcination process during manufacture) •
2. Aluminum and zinc: Up to 10% (act as
buffers and partially neutralize phosphoric
acid, thus tempering the reactivity of the liquid)
Other oxides: 1.6% (alter the working
characteristics and final properties of the
cement :- Bismuth trioxide
- Silicon dioxide
3. Water (33%

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COMMERCIAL NAMES :
• Confit
• Harvard
• Zinc cement improved
• Modern tenacin
Mixing time: 1–1.25 min
Setting time: According to ADA specification No. 8, it is 5–9 minutes

CLASSIFICATION
Type I—Fine grained: Film thickness less than 25 mm
– Luting permanent metallic restorations
– Cementation of orthodontic bands
Type II—Medium grained: Film thickness of 40 mm
– High strength thermal insulating base
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MANIPULATION
Instruments : Clean dry glass slab and stainless steel cement spatula
P/L ratio : Type I: 2.8 gm/ml for luting consistency
Type 2: 4.8 gm/ml for base consistency.
Proportioning : Suitable amount of powder is taken on a glass slab with the
help of cement spatula
• It is divided into two small increments, two bulk increments, followed by
smaller increments.
• Then two to three drops of liquid are taken in front of the small increments
and close the bottle immediately, to retain the water content or pH 67

MIXING
 It is initiated by
addition of small
increment of powder
to the liquid.
 This slow addition of
powder to the liquid
has the affect of
delaying the setting
slightly, creating
more working time
and reduces initial
acidity.
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Spatulation is done by rotatory motion over a large area of the slab, to
dissipate the heat of the chemical reaction and slows down the setting action to
a certain extent.
Large amount of powder (bulk increment) is then added during the middle of
the mixing to further saturate the liquid quickly with the newly forming
complex, i.e. ZnPO4 .
Finally small increments of the powder are incorporated one by one until the
desired ultimate consistency is reached.
Mixing time is about 60–75 sec.

FROZEN SLAB TECHNIQUE
The main objective of this manipulative technique is to prolong the working
time.
In this method a glass slab is cooled in a refrigerator to 6°C and the zinc
phosphate cement is mixed on this cooled glass slab.
More powder can be incorporated as some moisture will condense on the cool
glass slab.
 Advantages :
• Increases working time
• Decreases setting time
• Greater P/L ratio can be achieved, but mechanical properties remain almost
same.
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Precautions taken during mixing zinc phosphate cement :
• Liquid bottle should be kept closed when not in use to prevent water loss, as
loss of water will lower pH and slows down the reaction, increases setting
time.
• The liquid bottle which appears cloudy should be discarded.
• Liquid and powder should not be interchanged with those of different
batches.
• Last 1/5 th portion of the liquid should be discarded (as pH might have
changed) Liquid should be dispensed on the slab just before mixing.
• Consistency of the mix should be checked after adding each increment of
powder.
• Cement mix should be applied to the inner surface of the preformed
restorations or casting before it is seated on the prepared tooth cavity
(otherwise cement may set on the tooth before the restoration is seated).

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USES :
• It is primarily used as permanent cementation material to fix preformed
restorations or castings (inlays, crowns, bridges, etc.).
• Used to fix orthodontic bands.
• Used as a thermal insulating high strength base.
• It is also used as temporary or intermediate restorative material.
 MODIFICATIONS :
• Hydrophosphate water settable zinc phosphate cement
• Fluoride cements
• Germicidal cements: (Silver or copper cements)
• Zinc silico phosphate cements

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ADVANTAGES :
• It has adequate compressive
strength and modulus of elasticity
to resist fracture and
deformation/under stress.
• Easy manipulation procedure, and
less critical technique.
• Sets sharply to relatively hard
mass from a fluid consistency.
• Lower solubility than silicate
cement.
DISADVANTAGES :
• Pulpal irritation due to its high
initial acidity. Hence should not be
placed directly on exposed dentin.
• Lack of anticariogenic property.
• It is a brittle cement, poor tensile
strength.
• Lack of chemical adhesion to the
tooth.
• Soluble in oral fluids.
• Not aesthetic.

SILICATE CEMENTS
 Silicate cement is the oldest of the direct tooth colored materials.
 It was first introduced by Fletcher in 1873
 It became popular in 1904 when Steenbock introduced an improved version.
 Schoenbeck developed silicate cements that contained fluoride in 1908.
DISPENSING :
• It is available in both powder and liquid form
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COMPOSITION
POWDER
Silica SiO2 40% Gives strength translucency
Alumina Al2O3 30% Reacts with phosphoric acid
Na3PO4 , K3PO4 , CaO 5–7% Provide Al, Ca, K ions to form
matrix
Fluorides (CaF, NaF, KF,
lite)
23% Flux, decreases melting and fritting
temperatures, contributes
anticariogenic property
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LIQUID
Phosphoric acid 45% Reactor
Buffers - AlPO4 , ZnPO4 15 % Control setting time
Water 40 % Controls pH and setting
times

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 Commercial Names-
• Biotrey
• Silicap
• Achatit
 Mixing time: 1 minute
 Setting time: 3 to 8 minutes

MANIPULATION
Instruments required : Clean glass slab and a non-abradable, i.e. stellite (Cr-
Co-Ni alloys) or agate spatula.
Reason to use plastic spatula instead of stainless steel spatula :
• Since the silicate powder (glass) is a hard abrasive material, this can abrade
the stainless steel spatula and release carbon, iron and other impurities from
steel which can contaminate and discolour the mix and restoration.
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Use a clean glass slab and agate or stellite spatula.
Take suitable amount of powder and divide into two parts.
Later part is again divided into 3 or 4 smaller parts for adjusting the putty
consistency.
Take two drops of liquid (Powder/liquid ratio = 4:1). Add the large bulk of
powder and mix by overlapping, folding or tapping method in minimum area
to retain gel structure
Add increments one after the other, and get putty, glossy consistency (0.5 ml
mix placed in between two glass plates, and pressed by 2.5 kg, should form a
disc of 2.5 cm diameter).
Plastic spatula can be used on folding technique does not get abrade.

CONTRAINDICATIONS
1. Posterior restorations and stress–bearing areas like class I, class II cavities
2. Zinc oxide eugenol base should not be used (as diffusing eugenol cause
discolouration).
3. Cavity varnishes should not be applied on enamel surface where silicate
cement is applied
4. Mouth breathers should not be given silicate cement restorations.
5. Stainless-steel spatula should not be used.
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MERITS
• Anticariogenic property
• Good initial aesthetics
• High compressive strength (200
MPa).
DEMERITS
• High acidity for long time and
severe irritant causing pulp-death
• Colour changes due to syneresis,
imbibition and solubility (dark
margins–cement lines are formed)
• Lack of chemical bonding with
tooth.

ZINC SILICOPHOSPHATE
CEMENT
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ZINC SILICOPHOSPHATE CEMENT
ADA specification no : 21
This cement is the combination of ZnPO4 cement and silicate cement (hybrid
variety).
The main objective of combining both these cements, is to obtain the good
aesthetics and anticariogenic properties of silicate cements, lower initial
solubility and acidity of ZnPO4 cement.
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• Synthetic porcelain
• Silicate zinc cement
• Zinc silicate cement
• Filling synthetic porcelain.
Dispensing : Dispensed as powder and liquid in air-tight bottle with a nozzle.
Commercial name-
◦ Flurothin

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According to ADA specification No. 21, these are classified into 3 types :
• Type I: Luting or cementation material
• Type II: Temporary posterior filling material and IRM
• Type III: Luting and restorative cement (dual purpose cement).
Uses :
• It was used for cementation of aesthetic restoratives like ceramic (PJC) crowns.
• However, at present it is not used much due to the availability of better resin
and GIC materials.

COMPOSITION
POWDER
Silica 25% Provides translucency, strength and hardness
Alumina 25% Reactive ingredient
ZnO 15% Reactive ingredient
MgO 10% Increases strength
CaO 10% Imparts smoothness to the mix
Calcium fluoride and
sodium fluoride
15% Anticariogenic property, decreases fusion temperature (flux)
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LIQUID
Phosphoric acid 50% Reactive ingredient
Zinc phosphate and
aluminium phosphate
3–5% Buffers (stabilize the pH
of acids)
Water 45% Controls the rate of the
reaction

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MERITS
• Compared to zinc phosphate
cement it has: Higher strength and
abrasive resistance
• Anticariogenic due to fluoride
leaching
• Better mechanical bonding,
specially with ceramics
• Higher translucency similar to
ceramics.
DEMERITS
• Higher initial acidity
• Prolonged acidity causing more
pulp sensitivity
• More brittle
• Higher film thickness.

ZINC
POLYCARBOXYLATE
CEMENT
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ZINC POLYCARBOXYLATE CEMENT
ADA specification no . 61
It was the first dental cement which had chemical bonding with tooth structure
(adhesive dental cement) formulated by Dr. Smith in 1968.
It is now most widely used as thermal insulating base and also as luting
cement to fix metallic crowns, bridges and orthodontic bands.
 Alternative names :
• Zinc polyacrylate cement
• Zinc poly C
• Zinc poly F
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Special properties :
• Direct chemical bonding with tooth structure.
• It is a real cement.
• Excellent biocompatibility and kind to the pulp.
 Dispensing :
• Dispensed as powder and liquid system with a measuring scoop and paper
pad.
• It is also be supplied as single component system, i.e. powder which can
be mixed with distilled water.

COMPOSITION
POWDER
ZnO 80% Principle reactor
MgO 10% Decreases calcination temperature
SiO2 + Al2O3 2–8% Increases strength
Stannous fluoride 4–5% Improves mixing and physical properties,
modifies setting time, may impart anti-cariogenic
property, initially only
93

94
LIQUID :
• Aqueous solution of Polyacrylic acid
• Co-polymer of acrylic acid and unsaturated carboxylic acid and water.

95
 Mixing time, is only 30–45 seconds According to ADA specification No. 61,
should This have setting time < 9 min.
 Setting time for the commercial products, for luting purpose = 6–9 min
 Setting time for the commercial products for base cement = 3–5 min
 Commercial names-
• Poly F (Dentsply)
• Durelon
• Carboco (voco)

MANIPULATION
 Instruments required are glass slab or paper pad, stainless steel or plastic
spatula.
 Powder liquid ratio for luting cement = 1.5 gm/ml
 Powder liquid ratio for base cement = 2.3 gm/ml
 Proportioning : The required amount of powder is dispensed on the glass
slab by using the measuring scoop provided by the manufacturer and the
powder is divided into 1 bulk and 2 small increments. Take 2 or 3 drops of
liquid as suggested.
96

 Mixing is initiated by
addition of bulk increment
and followed by smaller
increments as the mixing
proceeds.
 The mixing is continued
until homogeneous mass is
formed.
 The mixing is done by
stroking or spatulation
technique.
 It should be completed
within 30 seconds to
provide sufficient working
time to carry out
cementation or base
operation. 97

98
Proper mix of polycarboxylate cement is some what thicker in appearance but
has a shiny glossy appearance, which indicates that polyacrylic acid is still
available to bond to the tooth structure, otherwise no retention will occur.
A proper mix of polycarboxylate cement forms a thin strand when pulled up
with spatula in case of luting consistency or hook like in case of base
consistency.
If the cement mix shows tackiness or cobwebbing it has already started setting
and should be discarded.

99
Uses :
• For cementation of cast-alloy restoration like metallic crowns and bridges.
• Cementation of porcelain restorations and orthodontic bands
• As thermal insulating bases
• As temporary filling materials.

100
MERITS
• Excellent biocompatibility when
pulp is not exposed
• Chemical bonding to the tooth
(enamel and dentin)
• Freshly mixed cement exhibits
shear thinning or pseudoplasticity
• Good thermal insulating materials
• Easy manipulation methods.
DEMERITS
• Accurate proportioning is required for
optimum properties
• Need for a clean surface to utilize adhesion
potential
• Shorter mixing and working time
• Low compressive strength than zinc phosphate
cement
• Soluble in oral fluids
• Anticariogenic properties, is not good when
compared with silicate or glass ionomer
cements
• Does not bond chemically with porcelain or
noble metal or base metal castings.

ZINC OXIDE EUGENOL CEMENT
 ADA SPECIFICATION NO. 30
These are obtundent, chemically neutral, physically low strength, thermal
insulating opaque restorative materials having long history.
According to ADA specification No. 30, they are classified into 4 types
according to their uses :
• Type I: Temporary cementation ...... comp strength 35 Mpa
• Type II: Permanent cementation ...... comp strength >35 MPa
• Type III: Temporary restoration...... comp strength >25 Mpa
• Type IV: Cavity lining ..................... comp strength >5 MPa
102

COMPOSITION
POWDER
Zinc oxide 69% Reactive ingredient
White rosin 29.3% Reduces the brittleness
Zn stearate 1% Plasticizer
Zn acetate, CaCl2 0.7% Accelerator
103

104
LIQUID
Eugenol 85% Reactor
Olive oil 15% 15% Plasticizer

105
 Commercial names-
Unmodified
Tempac
Cavitic
Tempbond
EBA alumina modified
Optow
Alumina EBA

106
Polymer modified
Fynal
IBM
Non – eugenol
Nogenol
Freegenol

107
 CLINICAL APPLICATIONS :
1. As long-term and short-term luting agents
2. As temporary and intermediate restorations
3. As root canal sealers, e.g., Grossman’s or Ricket’s sealers
4. Surgical packs
5. Impression pastes
 Mixing time is about 1–1.5 minutes for all the 3 varieties.
 Setting times :
• Conventional ZnO eugenol cement: 4–10 minutes
• Resin modified cement: 9 minutes
• EBA alumina cement: 6–10 minutes

MANIPULATION
 Instruments required :
• Glass slab, narrow bladed stainless steel spatula (or cement spatula).
 Powder/liquid ratio (approximate):
• Zinc oxide eugenol cement: 3 or 4:1
• Resin modified cement: 6:1
• EBA-alumina cement: 7:1
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109
 The powder bottle should be shaken well for uniform distribution of powder
particles, and suitable amount of powder is dispensed at one end of the glass
slab using cement spatula.
 The powder is divided into two bulk increments, followed by smaller
increments (The reaction is not exothermic and the pH is ~ 7).
 Dispense required amount of liquid drops (2 to 3 drops) in the middle of the
glass slab.

 Mixing is started by adding
two bulk increments one
after the other into the liquid
and mix is thoroughly
spatulated.
 Then small increments are
added one by one until
required consistency is
achieved.
 For luting consistency, the
mix should be thinner and
have a creamy appearance.
 For restorative consistency,
the mix should be thicker,
non sticky, and should be
able to roll it on the glass
slab. 110

MODIFICATIONS
Resin modified ZnO eugenol cements
EBA-alumina cement is for
Noneugenol cements
Zinc oxide eugenol endodontic sealer
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112
 Contraindication :
• Zinc oxide eugenol cements are contraindicated for using in contact with
Composite resins (eugenol can dissolve the resin and make it soft)
• GIC restorations (leaching eugenol can diffuse and cause discolouration).
Uses :
 Zinc oxide eugenol cements :
• Type I–temporary cementation
• Type II–permanent cementation
• Type III–temporary restorations
• Type IV–cavity liners
• These cements can also be used as pulp capping agents and root canal
sealants.

113
Resin modified ZnO eugenol cements :
• As these have higher strengths, they can be used for Permanent
cementations
• Cavity lining agents
• Temporary and intermediate restorations.
EBA-alumina cement is for :
• Permanent cementation
• Cavity liners and bases
• Intermediate restorations.

ADVANTAGES
• Obtundent–suitable for use to relieve postoperative sensitivity, pulp protection
from thermal, chemical and electrical insults.
• Good marginal sealing properties due to low dimensional changes during
setting.
• Resists marginal leakage.
• Sufficient strength for cementation–only for modified ZnOE cement.
114

DISADVANTAGES
• Low compressive strength of unmodified cement is inadequate for permanent
cementation (however, modified cements can be used for intermediate
restorations, cement bases and permanent cementations).
• Eugenol is a solvent for resins. Hence, contra-indicated to use as base for
composite resins.
• Eugenol leaches and may diffuse causing discolouration, if used as base for
glass-ionomer cements.
• Does not chemically bond with dentin, enamel or metallic restorations.
• Does not help to form reparative dentin.
• Not anticariogenic 115

GLASS IONOMER CEMENTS
 GIC was prepared by Dr. Wilson, Dr. Kent in 1972 and their first clinical use
was reported by Dr. Mclean and Dr. Wilson in 1975 and released for use as
ASPA cement (Fuji) with polyacrylic acid, citric acid conditioner, powders of
three shades, and two colour pigments.
• ASPA cement, (aluminosilicate polyacrylate cement)
• Glass Polyalkeonates
• Glass-ionomer cement
117

118
Special properties :
• GIC has desirable characteristics of both silicate and zinc polyacrylic
cement
• Excellent biocompatibility with the pulp
• Direct chemical bonding to the tooth structure
• Anticariogenic properties due to release of fluorides
• Porcelain like translucency which is derived from the glass
• Favourable bioactive properties
• Can also be used as a bone substitute for maxillofacial surgery and as a
cement for hip joint replacement

TYPES OF GLASS IONOMER CEMENTS
Type I: Luting cements
Type II: Restorative cements
Type III: Cavity liners, cement bases
Type IV: Fissure realants
Type V: Orthodontic cements
Type VI: Core build up material
 Metal modified GIC
• Silver alloy admix or miracle mix cement
• Glass cermet cement (ketac silver) 119

120
Resin modified GIC compomer, dicure, tricure systems.
Fuji VII: (Excellent material for prevention of caries, the world’s first high
fluoride non resin containing autocure GIC).
Fuji VIII and Fuji IX: These materials are new, high viscosity GICs
launched in 1990s– atraumatic restorative materials (ART) (also referred as
gaediatric or paediatric materials).
Pit and fissure sealants

121
 Dispensing :
• Powder liquid system
• Single component powder (distilled water)
• Preproportioned capsules.

COMPOSITION
LIQUID
Polyacrylic acid 40-50%
Tartaric acid improves the handling characteristics increases working
time
copolymer Itaconic acid
Malic acid
Tricarboxylic acid
122

123
POWDER
Silica 29% Does not take part in the reaction but
increases hardness and translucency
Alumina ( Al2O3) 16.5% Reacts with poly acrylic acid to give
aluminium poly acrylate matrix
Aluminium fluoride
Calcium fluoride
Sodium fluoride
7.3% These act as flux and reduce fusion
temperature Improves the working
characteristics Provide anticariogenic
property
Aluminium phosphate 9.9 % Control ls the setting time

124
 Mixing time = 30 seconds (follow manufacturer’s instructions)
 Working time 1½ minutes
 Setting time :
• Type I : 6–9 minutes
• Type II : 3–5 minutes
• Type III : 4–5 minutes

MANIPULATION
Instruments required:
• Glass slab or paper pad and plastic or agate spatula.
 Powder/liquid ratios: P/L
• Type I: 1.25–1.5 gm/ml
• Type II: 3 gm/ml
• Type III: 1.5 gm/ml (for cavity lining and 3 gm/ml for base).
125

126
Take required amount of powder (1 scoop) (follow manufacturer’s
instructions) on one side of the glass slab, and divide the powder into one bulk
and two small increments.
Place 2–3 drops of liquid for luting, or one drop for restoration, on the same
side, near the bulk.
Larger portion of the powder (bulk increment) is mixed into the liquid with a
plastic spatula followed by smaller increments.
Mixing is done by tapping, stropping, folding or over lapping methods.
The total mixing time is 30–45 seconds.
The luting cement is a fluid similar to ZnPO4 cement mix.
The restorative mix should have a putty like consistency and a glossy surface.
The glossy surface indicates the presence of unreacted polyacrylic acid which
can bond with the tooth surface.

USES
Type I–luting cement:
• For cementation of metallic crowns, bridges, porcelain restorations,
orthodontic bands
Type II–restorative cement :
• Restoration of class V and III cavities
• Restoration of abraded and cervical eroded areas without any cavity
preparation
• Restoration of deciduous teeth
• Repairing defective margins in restorations
127

128
Type III–GIC:
• Designed for lining the cavities, used as cement bases and pit and fissure
sealants.
 Modified GIC :
• The miracle mix and glass cermet cement which are metal modified
• GICs can be ideally used for core build up where there is residual dentin
support.
• These materials can also be used in restoring deciduous tooth.
• Resin modified GIC can be used as a liner under composite resin
restoration.

129
 Contraindications :
• GIC are brittle in nature and hence contraindicated for class II and class
VI cavities for replacement of lost cusp-areas.
• Cannot be used as amalgam replacement material
• Should not be used in contact with the zinc oxide eugenol cements.
 MODIFICATIONS :
• Metal reinforced glass Ionomer cement
• Resin-modified glass Ionomer Cement
• Fuji VII
• Fuji VIII and Fuji IX

RESIN MODIFIED GIC
 Antonucci et al. originally used the term resin modified glass ionomer cement
as the trivial name and resin-modified glass polyalkenoate as the systemic
name.
130

131
• Powder- ion- leachable glass and initiators for chemical/light curing
• Liquid- four main ingredients-
 Methacrylate resin (bisGMA) enables polymerization
 Polyacid which reacts with ion-leachable glass to allow the acid base
reaction
 Hydroxy-ethyl methacrylate(HEMA), a hydrophilic methacrylate which
enables both resin and acid to co-exist in an aqueous solution
 Water allows ionization of acid component so that an acid base reaction
can occur
 Other components- polymerization activators and stabilizers

132
◦ Setting reaction- dual mechanism
- Acid base reaction
- Chemically activated polymerization of the resin modified glass ionomer
cement is known as Dark Cure
◦ Advantages- compressive, diametric, tensile and flexural strength good but
less than composite, - less sensitive to moisture contamination, easy
manipulation and use, adequately low film thickness, fluoride release, minimal
post operative sensitivity, high bond strength to moist dentin (14MPa)
◦ Disadvantages- dehydration shrinkage 3 months after maturity, HEMA
increases water sorption an may have hygroscopic expansion, rare allergic
response, hard to remove.
◦ Recommended for luting metal or PFM crowns an FPD’s to tooth, amalgam,
resin composite or glass ionomer core build ups.

DUAL CURE METHOD OF CEMENTATION
133

COMPOMER
• It contains microfilled resin composites.
• Compomer = composite + glass ionomer
• Available as either powder/liquid or as two pastes or in a automix syringe
134

135
• Powder- strontium aluminofluorosilicate,
metallic oxides,
chemical-activated and/or light activated initiators.
• Liquid- polymerizable methacrylate/ carboxylic acid monomers,
multifunctional acrylate
monomers and water.

RESIN CEMENTS
 Synthetic resin cements based on methyl methacrylates have been available
since 1952.
 These materials were most widely used for the cementation of inlays, crowns
and other appliances.
 Since 1986, these resin cements have retained popularity because of their use
in the cementation of porcelain veneers, cast crowns and orthodontic bands.
Classification :
• Type I Unfilled resins
• Type II Filled resins
137

138
(ADA specification no. 27) describes the following three categories of
composite cements:
• Class I: Self-cure materials
• Class II: Light-cure materials
• Class III: Dual cure materials
Self-cure resin cements are available as a powder/liquid system or two-paste
system that is dispensed on a paper pad and is mixed for 20–30 seconds.
Light-cure resin cements are photoinitiated in the presence of
camphoroquinone–amine system. They consist of a base paste only with no
mixing necessary.
Dual cure cements come in a base–catalyst (paste–paste) form and must be
mixed before use. New automix dispensers have made manipulation easier and
uniform.

APPLICATIONS
It is a choice in cementation of resin bonded bridges.
These are widely employed for intermediate prosthesis.
It is also involves in direct attachment of orthodontic brackets.
Used to attach either resin or ceramic veneers to the surface of anterior teeth
using the acid etch technique.
139

140
◦ ADVANTAGES
• High adhesion qualities with
pretreatment of fitting surfaces
• High hardness
• Low solubility
• High mechanical properties
• Good esthetic
◦ DISADVANTAGES
• Diffculty in handling
• No fluoride release
• Occasional postoperative
sensitivity
• Pulpal irritant due to the monomer
content

141
• Based on methyl methacrylate-
1950’s, poor physical properties, high polymerization shrinkage, high
microleakage (low filler content); high residual amine levels and hence colour
shift after polymerization.
• Aromatic Dimethacrylate-
1963 Dr Rafael Bowen.
bisGMA; 2,2-bis[4-(2 hydroxyl- methacryloxypropoxy) phenyl] propane
resin; is an aromatic ester of methacrylate, synthesized from an epoxy-resin
and methyl methacrylate
To reduce the viscosity of bisGMA, TEGDMA is added.

142
oAdvantages- high compressive an tensile strength, low solubility,
micromechanical boning to prepared enamel, dentin, alloys, and ceramic
surfaces, available in a wide range of shades an translucencies.
oDisadvantages- critical manipulation technique, high film thickness, marginal
leakage, pulp reaction when applied to vital dentin, no fluoride release, low
modulus of elasticity, difficult to remove hardened resin, low early bond
strength; hence patient advised not to eat 1 hour post cementation.

ADHESIVE RESIN CEMENT
• To improve the adhesive bond of bisGMA, adhesive monomers have been
added that enable chemical bonding to both the tooth structure and the suitably
prepared metal surfaces. These are bifunctional phosphate monomers and
carboxylic monomers.
• Resin bonding is facilitated by the affinity of these monomers for the metal
oxides present on the base metal alloys without the need for acid etching.
• Example- Panavia F , C&B Superbond.
143

CALCIUM HYDROXIDE
Forms of reparative or secondary dentin and this action appears due to its large
alkaline pH and remineralisation action.
In 1930 Hermann introduced calcium hydroxide to promote healing in many
clinical situations .
The introduction of this material in the US was by Teuscher and Zander in
1938.
Dispensing :
• Two paste chemically activated system and single paste light activated system
146

COMPOSITION
BASE PASTE
Glycol salicylate 40% Reactive ingredient
Calcium tungstate 16% Radio-opacifiers
TiO2 14% Fillers
Calcium sulphate 30% Gives strength and colour
to the paste
147

 Composition:
Single paste system (Dycal) Ca(OH)2 + BaSO4 (radio-opacifiers) + urethane
dimethacrylate + photoinitiators + accelerators
All these ingredients are dispensed in ethylene toluene sulfonamide = 39.5%.
REACTOR PASTE
Ca(OH)2 50% Reactive ingredient
ZnO 10% Reactive ingredient
Zn stearate 0.5% 0.5% Strength
148

149
MANIPULATION :
• Equal lengths of two pastes are mixed to uniform consistency, (colour) and
used as required
Setting time – 2.5–5.5 minutes
Working time : < 10 sec.
Uses :
• As pulp capping agent
• Can be used as a liner in deep cavity preparation

150
◦ ADVANTAGES
• Promotion of growth of secondary
or reparative dentin
• Neutralize strong acids
• Sealing of exposed dentin surface
• Easy manipulation method.
◦ DISADVANTAGES
• Cannot provide thermal insulation
at low thickness
• It has very low strength when
fully set
• Dissolves under acidic condition
• Weakened by exposure to
moisture.

INDICATIONS OF LUTING CEMENTS
152

FLUORIDES IN DENTAL
MATERIALS
153

FLUORIDES IN DENTAL MATERIALS
 Fluoride releasing cements include Silicate, glass ionomer and
silicophosphate cements
 Compomers acquire fluoride through the addition of fluoride salts that lower
the fusion temperature of the glass.
 Investigations indicate anticariogenic property characterized by the addition
of fluoride cements to resins, amalgam, ZuPO4 cement, ZOE, Pit and fissure
sealants, cavity varnishes.
 Addition of fluoride can be achieved physically by incorporating soluble
fluoride salt within the bulk material or by adding virtually insoluble fluoride
containing minerals as fillers.
154

155
A fluoride releasing zinc phosphate cement was developed, but its solubility
was extremely high.
The sustained fluoride releasing capacity for a period of 18 months by certain
restorative resins were developed but the rate at which they released fluoride
was at a level much lower than that released from glass ionomer cement.
Both the metal – reinforced systems of glass ionomer cement release
appreciable amounts of fluoride initially, but the magnitude decreases
substantially over time.
Less fluoride is released from the cermet cement, becauses a portion of the
glass particle is metal coated.
For the admix cement, the metal filler particles may not bond well to the
cement matrix; thus the filler cement interfaces become additional surface
areas for fluoride leaching.

SOLUBILITYAND
DISINTEGRATION
156

SOLUBILITY AND DISINTEGRATION
◦ An important requirement of dental cements is that they be resistant to
solubility and disintegration in the oral cavity.
◦ If the luting cement dissolves or deteriorates so that fragments are lost from
beneath a restoration , leakage ensues with subsequent adverse effect including
sensitivity, caries, or both.
◦ Dissolution or disintegration of restorative cement results in the loss of surface
material, which leads to eventual replacement of restorations.
◦ ADA specification No.96 describes the use of 0.1 M lactic acid / sodium
lactate (pH=2.74) to test the erosion rate
157

158
◦ Calcium hydroxide has the highest solubility, it ranges from 0.4wt% to 7.8wt%
in distilled water in 24 hr.
◦ Properly cured resin cement is not soluble in oral fluid.
◦ Weight changes after immersion in water is caused by the leaching of the
unreacted monomer or solubility of filler particles.

RECENT ADVANCEMENTS
Bioactive Cements
◦ Crown manufacturer NuSmile Ltd. announced the launch of BioCem Universal
Bioactive Cement, designed for use with custom- fabricated zirconia and glass
ceramic restorations.
◦ BioCem forms a superior bond between dentin and zirconia, lithium silicates
and disilicates, or leucite glass ceramic materials. Moreover it actively mimics
the physical and chemical properties of natural tooth and surrounding
structures.
◦ BioCem also features a unique shock- absorbing, rubberized resin component,
making it tougher than traditional cements.
159

160
◦ Additional studies have proven that BioCem forms hydroxyapatite, which is
available to integrate with and replenish tooth structure.
◦ BioCem also releases phosphate, calcium and fluoride ions into the oral
environment.
◦ Its formulated and packaged into a convenient, simple to use, low waste
delivery system that does not require the tooth or zirconia restoration to be
primed.

NexusTM Universal
• Nexus™ Universal is an adhesive resin cement formulated to allow clinicians
to cut their procedure steps by up to half.
• It also offers a flexible workflow to accommodate a clinician’s preferred
cementation technique.
• Nexus Universal is reportedly the first cement to offer total dark-cure
compatibility with any leading universal bonding agent.
• With its redox indicator system, Nexus virtually eliminates discoloration for
better color stability and long-term appearance.
161

162
• It is compatible with a full range of indirect restorations, as well, including
resin, zirconia, gold base metal alloys, and lithium disilicate.

Provicol QM
• Provicol QM Plus features strong retention and secure adhesion to ensure that
temporary restorations remain in place for as long as necessary.
• The non-eugenol temporary cement is formulated with calcium hydroxide and
can reduce post-operative sensitivities while helping prevent caries with its
antimicrobial properties.
• Its low film thickness increases ease-of-use and accuracy of fit when placing
temporary crowns, bridges, inlays, and onlays.
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164
• Further enhancing speed and convenience, Provicol QM Plus is applied from
an easy QuickMix syringe and excess material can simply be peeled off.

ZR-Cem
• ZR-Cem is a universal, self-adhesive resin cement specially formulated for
zirconia that reportedly delivers superior bond strength and color stability.
• Its unique formula contains 1-MDP, which enables a strong bond to all
ceramic materials, dentin, and enamel. ZR-Cem’s BPO/amine-free initiation
system is said to translate to superior, lasting color stability compared to other
cements.
165

166
• No pre-treatment of the crown or bonding is required, making it easy to use.
Dual-cured with optimal viscosity, it handles well, is easy to clean up, and does
not require refrigeration.

ACTIVA Presto
• ACTIVA Presto features a hydrophilic resin it is able to function optimally in
the wet intraoral environment. The material is able to function much like
natural dentition in the way it combines both the ability to interact with the oral
environment for the exchange of calcium, phosphate, and fluoride ions, and the
shock absorbing properties it exhibits. In look, feel, and function ACTIVA
Presto aims to be as close as possible to the natural material it replaces.
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169
Garner JR, wajdowicz MN, duvall NB, roberts HW. Selected physical
properties of new resin-modified glass ionomer luting cements.
• They did an in vitro study to evaluate selected physical properties of 2 newly
marketed RMGI luting agents and compare the findings with traditional
materials.
• Materials and method used were Specimens (N=12) of Nexus RMGI,
UltraCem, GC Fuji Cem 2, and RelyX Luting Plus were fabricated using
standardized molds for flexural strength and fracture toughness according to
manufacturer recommendations and stored in physiologic phosphate-buffered
saline solution at 37 o C until testing.
Journal of Prosthetic Dentistry. 2017 Feb;117(2):277-282.

170
• Specimens were tested at 1 and 24 hours, 1 week, and 1 month. Mean values
for flexural strength, flexural modulus, flexural toughness, and fracture
toughness were determined. Additionally, film thickness (N=12) for each
material was determined following Amerian National Standards
Association/American Dental Association (ANSI/ADA) specifications. Mean
results were analyzed with Kruskal-Wallis and Mann-Whitney U tests (a=.05).
• Result found was that all luting agents exhibited a similar film thickness that
met ANSI/ADA requirements for aqueous-based luting agents. Nexus RMGI
surprisingly demonstrated significantly greater flexural strength and fracture
toughness at 1 hour, which decreased significantly at 24 hours, making it
similar to the other materials evaluated. All materials had similar flexural
strength values at 7 days.
Journal of Prosthetic Dentistry. 2017 Feb;117(2):277-282

171
• The conclusion drawn was that the, physical property performance was
material dependent. Nexus RMGI demonstrated greater early physical
properties that were significantly less at 24 hours. UltraCem, GC Fuji Cem 2,
and RelyX Luting Plus demonstrated the increasing physical property
development that is normally associated with polyalkenoate-based systems.
Journal of Prosthetic Dentistry. 2017 Feb;117(2):277-282

172
Siqueira PC et. al , Cytotoxicity of glass ionomer cements containing silver
nanoparticles.
• A study was done to evaluate the cytotoxicity of conventional and resin-
modified glass ionomer cements (GIC) with and without addition of NAg.
• In this NAg were added to the materials at two different concentrations by
weight: 0.1% and 0.2%. Specimens with standardized dimensions were
prepared, immersed in 400 µL of culture medium and incubated at 37°C and
5% CO2 for 48 h to prepare GIC liquid extracts, which were then incubated in
contact with cells for 48 h. Culture medium and 0.78% NAg solution were
used as negative and positive controls, respectively. Cell viability was
determined by MTT and Trypan Blue assays. ANOVA and the Tukey test
(α=0.05) were used for statistical analyses.
Journal of Clinical Dentistry 2015 Dec 1;7(5):e622-7.

173
• Results found were that both tests revealed a significant decrease in cell
viability in all groups of resin modified cements (p<0.001). There were no
statistically significant differences between groups with and without NAg
(p>0.05). The differences in cell viability between any group of conventional
GIC and the negative control were not statistically significant (p>0.05).
• Conclusion drawn was that NAg did not affect the cytotoxicity of the GIC
under evaluation.
Journal of Clinical Dentistry. 2015 Dec 1;7(5):e622-7

SUMMARY
Zinc phosphate cement has long served as the universal luting cement.
Its advantages includes good handling characteristics and a proven longevity
in the oral cavity when it is used for cementation of well designed and well
fitting restorations.
Its disadvantages include pulp irritation, lack of adhesiveness to tooth
structure, and lack of anticariogenic properties.
Zinc phosphate cement is not suitable when the mechanical retention is poor
or when the aesthetic demand is high.
175

176
The main advantage of improved zinc oxide eugenol cement is their
biocompatibility.
The physical and mechanical properties and the handling characteristics
generally inferior to those of other long term luting cements.
The properties of zinc Polycarboxylate cement are good compared with those
of ZnPO4.
The outstanding characteristics are their blandness to the pulp and formation
of an adhesive bond to tooth structure.

177
Disadvantages include the short working time and limited capability for
fluoride release.
Their short working time limits their use to single units or three unit fixed
partial dentures (bridges).
These cements have decreased in popularity, but they are still often used for
patients who have reported a history of postoperative sensitivity.
Glass ionomer luting cements bond to tooth structure and release fluoride.
Compared with zinc phosphate cements, glass ionomer cement show a greater
resistance to disintegration in oral cavity and comparable mechanical
properties

178
With the exception of lower elastic modulus, a primary disadvantage of these
cements is the slow maturing process that is required to develop their ultimate
strength.
The translucency of glass ionomer cement make them useful for cementing
ceramic prostheses.
However their low stiffness may allow excessive elastic deformation of the
ceramic prosthesis, which may result in fracture of brittle prosthesis.
The fluoride releasing capability makes glass ionomer cement the material of
choice for restoration.

179
The durability of compomers is inferior to that of resin based composites.
 hus they should only be used for low stress areas
Resin cements can be used for all types of cementation , most notably for
prosthesis with poor retention and for all-ceramic prosthesis when the demand
for aesthetic “perfection” is very high.
A primary problem of modern resin cement centers on the handling
characteristics , in that it is critical to remove flash immediately after seating
of the restoration.

180
Thus it is readily apparent that no single type of cement satisfy all the ideal
characteristics.
One system may be better suited to one task than another, and it is prudent for
the dentist to have several types available.
Each situation should be evaluated on the basis of the pertinent environmental,
biological, and mechanical factors

REFERENCES
• Kennith J Anusavice: Phillips’ Science of Dental Materials 11th edition.
• Theodore M. Roberson: Sturdevant’s Art and Science of Operative Dentistry 4th
edition.
• Robert G. Craig and John. M: Restorative Dental Materials 11th edition.
• Alireza Farhad and Zahed Mohammedi Esfahan: Calcium hydroxide : a review.
International Dental Journal 55, 293-301, 2005.
• Journal of Clinical Dentistry May 2015
• A Review of Luting Agents- International Journal of Dentistry Nov 2011
• Conventional and Contemporary Luting Cements, Journal of Indian Prosthodontic
Society (April- June 2010)
• Fundamentals of fixed Prosthodontics- fourth edition Shillingburg 181

182
• Hilton TJ: Cavity sealers, liners, and bases: Current philosophies and
indications for use. Oper Dent 21:134, 1996.
• Sasanaluckit P, Albustany KR, Doherty PJ, and Williams DF: Biocompatibility
of glass ionomer cements. Biomaterials 14:906, 1993.
• Wolff MS, Barretto MT, Gale EN, et al: The effect of the powder-liquid ratio
on in vivo solubility of zinc phosphate and polycarboxylate cements. J Dent
Res 64:316, 1985.

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