Resin Luting Cements (2nd edition) pdf

1
Resin luting cements
Five textbooks
Craig - Phillips
Art & Sciense
Contemporary fixed
prosthodontics
Introduction to dental
materials

2
Resin luting cements
Items to be covered
 Uses
 Types
 Types according to method of activation
 Light-cured
 Chemical-cured
 Dual-cured
 Types according to development & the presence of filler
 Unfilled resin
 Composite resin cement
 Types according to adhesion
 Conventional
 Adhesive
 Self-adhesive
 Composition
 Reaction
 Properties
 Degree of conversion
 Cytotoxicity
 Mechanical properties
 Water sorption & solubility
 Film thickness
 Postoperative sensitivity
 Fluoride content & release
 Translucency & esthetics
 Bonding to the tooth structure
 Manipulation
 Resin-to-tooth bonding
 Resin-to ceramic bonding
 Resin-to-metal bonding
 Resin-to-resin bonding
References
Craig's restorative dental materials
Sturdevant's art and science of
operative dentistry
Contemporary fixed prosthodontics
Introduction to dental materials
Phillips' science of dental materials

3
Uses (applications)
Cementation of:
1. Indirect restorations, including veneer, inlay, crown & bridge.
2. Posts: prefabricated posts.
3. Orthodontic brackets.
Note: orthodontic bands are commonly cemented by glass ionomer cements
(GIC). (Phillips)
4. Different types of materials, including:
 Ceramics
 Resin composites: laboratory-processed (indirect)
 Metals: if extra retention is needed
5. Resin cements are the material of choice for cementation of ceramic veneers
(restorations), why? (Give reason)
 Translucent, good esthetics & various shades.
 Reduce fracture incidence of ceramics:
 High strength & good bond strength.
Types according to the method of activation
1. Light-cured
2. Chemical-cured (self-cured)
3. Dual-cured: combination of chemical & light activation

5
Light-cured resin cements
 Less common, why? (Give reason)
 To avoid the potential incomplete polymerization under a prosthesis.
 Not cure (polymerize) properly with large inlays & crowns, why?(Give reason)
 Light would be unable to penetrate to the full depth of inlay & crown.
 Recommended for bonding the veneer, why? (Give reason)
 More color stability
 More working time
than the self-cured or dual-cured versions.
 Uses: cementation of:
 Thin translucent prosthesis (ceramic & resin)
 Ceramic veneers
 Orthodontic brackets (Craig)
Chemical-cured resin cement
 Uses: cementation of:
 All types of restorations. (Phillips)
 Metal (cast) restorations: if extra retention is needed.
 Translucent restorations with thickness more than 2.5 mm.
(Phillips, p. 330)
 Inlays: chemical polymerization is preferred, why? (Give reason)
 To ensure maximum polymerization in the less accessible
proximal areas.
 Clinical performance: chemical-cured > dual-cured.
(Contemporary: p. 784)

6
Dual-cured resin cement
 Most commercial products
 Suitable working time
 High degree of conversion even in areas not reached by light. (Craig)
 Slow reaction until exposed to light → at which point the cement hardens
rapidly.
 Uses: cementation of translucent restorations with thickness less than
2.5 mm. (Phillips, p. 330)
Unfilled resin (1950s)
 Without filler
 High polymerization shrinkage
 Poor biocompatibility
 Unsuccessful
Composite resin cement
 Contains filler.
 Greatly improve properties.
 ↑ filler loading (content) → ↓ resin content → ↓ problems of resin, such as
↓ polymerization shrinkage.
 The filler loading (content) is lower than composite restorative material, why?
(Give reason)
 To ensure low film thickness (required for cementation).

7
Types of resin cements (Introduction to dental materials, p. 221)
1. Aesthetic light- / dual-cure composite resins (conventional)
2. Adhesive chemical- / dual-cure resin cements
3. Self-adhesive dual-cure resin cements
1. Aesthetic light- / dual-cure composite resins
 Conventional resin cement
 Not adhesive
 Used when aesthetic is important
2. Adhesive chemical- / dual-cure resin cements
 Adhesive resin cement
 Improve the adhesive bond to metal
 Still require a dentin bonding agent
3. Self-adhesive dual-cure resin cements
 Self-adhesive resin cement
 Etching, priming & bonding in a single material. (Craig)
= Single step application (Introduction to dental materials, p. 222)
= Not require any pretreatment of the tooth. (Art & Science, p. 159)
= Not require etching & bonding (Phillips)
= Avoid the need for separate etching & bonding. (Craig)
 Simultaneous adhesion to tooth & restoration.
 Become popular, why? (Give reason)
 Simpilicity
 Lowest post-cementation sensitivity.
 Universal adhesive.
 Good bond strength to dentin. (contemporary, p. 781)

8
Composition
Conventional resin cement
 Very similar composition to restorative composites. (Craig)
 Four major components:
 Organic resin matrix
 Inorganic filler
 Silane coupling agent
 Initiator-accelerator system
Adhesive resin cement
 Combine:
 MDP with Bis-GMA
 or 4-META & MMA in the liquid, and PMMA in the powder. (Craig)
Notes:
 MDP: Methacryloyloxydecyl dihydrogen phosphate.
 4-META: Methacryloxyethyl trimellitic anhydride.
 Bond chemically to metal oxides.
 High affinity of carboxylic acid & phosphoric acid derivative-containing resins
for metal oxides.

9
Self-adhesive resin cement
 Acidic functional monomer:
 Etch the tooth.
 Based on phosphates & phosphonates.
 Bond to base metal alloys (metal oxides) & ceramics.
 Simultaneous adhesion to tooth & restoration
 Examples:
 10-MDP: Methacryloyloxydecyl dihydrogen phosphate.
 Penta-P: dipentaerythritol pentacrylate phosphate.
 Glycerol dimethacrylate dihydrogen phosphate.
 Alkaline glass: acid neutralizing fillers, such as fluoroalumino silicate (found
in glass ionomers).
 Note: the remaining acidity is neutralized by alkaline glass. (Craig)
 Alkaline amines become inactive in an acidic environment.
 Therefore, a new initiator system has to be developed.
 Each product has its own acid-resistant initiator/accelerator system.
(Introduction to dental materials, p. 222,223)
Commercial products
Conventional resin cement
 RelyX ARC (3M/ESPE)
Adhesive resin cement
 Super-Bond C&B (Sun Medical) → contains 4-META.
 Panavia 21 (Kurary) → contains MDP.
Self-adhesive resin cement
 RelyX Unicem (3M/ESPE): contains phosphoric acid-modified methacrylates
 SmartCem2 (Dentsply): contains PENTA.
 MaxCem Elite (Kerr):contains glycerol dimethacrylate dihydrogen phosphate
 Panavia SA Cement Plus (Kurary): contains MDP.
 Speed CEM Plus (Ivoclar Vivadent): contains MDP.
 Solocem (Coltene): contains MDP & 4-META.

10
Structure of MDP
Contemporary: p. 780

11
Reaction
 Free radical polymerization reaction.
 Activator → activates the initiator → release free radical → initiate the
polymerization reaction.
 Acidic groups (phosphate & carboxylate) bind with calcium in hydroxyapatite.
 At later stages, the remaining acidity is neutralized by alkaline glass.
 Anaerobic setting reaction:
 Some commercial products do not set in the presence of oxygen.
 Oxygen barrier (protection): a polyethylene glycol gel (Oxyguard II)
can be placed over the restoration margins
 Oxygen barrier (protection).
 To ensure complete polymerization.
(Contemporary, p. 708)
Properties
 Degree of conversion
 Cytotoxicity
 Mechanical properties
 Water sorption & solubility
 Film thickness
 Postoperative sensitivity
 Fluoride content & release
 Translucency & esthetics
 Bonding to the tooth structure
Degree of conversion
 In dual-cured cements:
 Light-curing → ↑ degree of conversion →
 ↑ mechanical properties
 ↓ residual monomer → ↓ cytotoxicity of dual-cured cements.

12
Cytotoxicity
 Unfilled resin > composite resin cement, why? (Give reason)
 In dual-cured resin cements, light-curing → ↓ cytotoxicity, why? (Give reason)
 After 7 days, Bis-GMA-based dual-cured cements are less cytotoxic than zinc
polyacrylate.
 Adhesive resin cements are less biocompatible than glass ionomer cement,
especially if they (resin cements) are not fully polymerized.
 Pulp protection: important when the thickness of remaining dentin is less
than 0.5 mm.
 In self-adhesive resins: slightly acid-soluble glass filler reacts with the acidic
monomer → increases the pH to a neutral level.
(Introduction to dental materials, p. 222)
Mechanical properties
 Compressive strength:
 Resin cements (dual- & light-cured) > acid-base cements.
 ↑ Filler content & ↑ degree of conversion → ↑ mechanical properties.
 In dual-cured resin cements, light-curing → ↑ mech prop, why? (Give reason)
 Self-adhesive resin cements have slightly (somewhat) lower mechanical
properties than conventional resin cements.

13
Water sorption & solubility
 Virtually insoluble in oral fluids. (Phillips)
 Resin cements < resin-modified glass ionomer.
Notes:
 However, discoloration of the cement line may occur after a prolonged
period. (Craig)
 Shrinkage: 2–5%.
 Water sorption:
 Self-adhesive resin cement > conventional, why? (Give reason)
 Unreacted acid groups → ↑ water sorption. (Craig)
Film thickness
 Low viscosity & film thickness. (Craig & Phillips)
 The filler loading (content) is lower than composite restorative material, why?
(Give reason)
 To ensure low film thickness. (Introduction to dental materials, p. 225)
Postoperative sensitivity
 = Post-cementation sensitivity = Post-treatment sensitivity.
(Contemporary: p. 778, 781)
 Self-adhesive resins:
 Lowest incidence of post-cementation sensitivity, why? (Give reason)
 Because the dentin does not need to be etched with phosphoric
acid. (Craig)
 Significant advantage.

14
Fluoride content & release
 Self-adhesive resin cement:
 Low fluoride content (around 10%) less than glass ionomer & resin-
modified glass ionomer.
 Fluoride release:
 Decrease rapidly with time.
 Its beneficial effects have not been clinically proven.
Translucency & esthetics
 Various shades & translucencies.
 Amines degrade over time, altering the shade of the cement. (Craig)
 Discoloration of the cement line may occur after a prolonged period. (Craig)
 Note: resin cements are the material of choice for cementation of ceramic
veneers (restorations), why? (Give reason)
 Self-adhesive resin cement is not recommended for bonding of ceramic
veneers, why? (Give reason)
 Ceramic veneers are cemented by light-cured resin cements.
 Because of the need for high esthetics.
(Introduction to dental materials, p.223)

15
Bonding to the tooth structure
 Micromechanical retention (interlocking) by acid etching.
 Chemical bond between acidic groups (if present) & calcium in tooth structure.
 Self-adhesive resin cement:
 Simultaneous adhesion to tooth & restoration.
 Etching, priming & bonding to tooth in a single material. (Craig)
= Single step application (Introduction to dental materials, p. 222)
= Not require any pretreatment of the tooth. (Art & Science, p. 159)
= Not require etching & bonding (Phillips)
= Avoid the need for separate etching & bonding. (Craig)
 Acidic functional monomer:
 Etch the tooth.
 Based on phosphates & phosphonates.
 Bond to tooth, base metal alloys (metal oxides) & ceramics.
 Simultaneous adhesion to tooth & restoration.
 Bond strength to dentin: comparable to resin cements.
 Bond strength to enamel: less than conventional resin cements.
 Selective etching (with phosphoric acid gel to enamel only) →
↑ bond strength to enamel.
 Notes: enamel bonds are compromised with most self-etching primers.
 This deficiency may be overcome using the “selective etch”
technique. (Art & Science, p. 482)
 Self-adhesive resin cement is not suitable for bonding of orthodontic
brackets, why? (Give reason)
 Because bonding to enamel is less than that achieved with the etch-and-
rinse & self-etching dentin-bonding agents.

16
Phillips: p. 311

17
Manipulation
 The procedure for preparing tooth surfaces remains the same for each system.
 But the treatment of the prosthesis differs depending on the composition
of the prosthesis. (Phillips)
Resin-to-tooth bonding
 Etch-and-rinse or self-etch bonding systems.
 Etch-and-rinse:
 Phosphoric acid etching (35–37%), then rinsing & gentle drying.
 Bonding agent application → form resin tags → ready for luting of
restoration with resin cement.
 Self-adhesive resin cements do not require etching & bonding.
Resin-to ceramic bonding
 Silica-based or glass-matrix ceramics:
 Examples: feldspathic porcelain, leucite-reinforced & lithium disilicate-
reinforced ceramics.
 Hydrofluoric (HF) acid etching (5–10%), rinsing & air-drying.
 Silane coupling agent is applied.
 After try-in & prior to applying the silane, cleaning the ceramic surface
with isopropyl alcohol, acetone or phosphoric acid is needed.
 To remove any surface contaminants, such as saliva.
 For some silane products, it is recommended that a phosphoric acid
solution is added to the silane to hydrolyse it prior to its application.
 Other silane products are already hydrolysed with limited shelf
life. (Introduction to dental materials, p.224)
 Resin cements are the luting agent of choice, why? (Give reason)

18
Introduction to dental materials: p. 223
 Self-adhesive resin cements have lower bond strength to etched glass-
matrix ceramics than conventional resin cements.
(Art & Science, p. 159)
 Oxygen barrier (protection): some products of resin cements do not set
in the presence of oxygen (anaerobic setting reaction), such as
Panavia 21.
 A polyethylene glycol gel (Oxyguard II) can be placed over the
restoration margins → Oxygen barrier (protection).
→ To ensure complete polymerization.
 Note: sandblasting with alumina particles (airborne-particle abrasion):
* Immediate lower the flexural strength of feldspathic porcelains &
lithium disilicate-reinforced ceramics.
* ↓ bond strength when HF is not used. (Art & Science, p. 158)
 The primary source of retention remains the etched porcelain itself.
 Silanation → only a modest ↑ in bond strength.
 However, silanation is recommended, why? (Give reason)
→ ↓ marginal leakage & discoloration. (Art & Science, p. 297)

19
 Polycrystalline ceramics:
 HF etching does not improve the bond strength, why? (Give reason)
 Because polycrystalline ceramics do not contain a glass matrix.
 Newest protocols: (Art & Science, p. 158)
 Airborne-particle abrasion.
 Tribochemical silica coating, followed by silane application.
 Primers or silane mixed with functional monomers, such as
10-MDP.
 Micromechanical retention plays more important role than chemical
bonding. (Art & Science, p. 158)
 Zirconia restorations:
 Should be cemented with resin-modified glass ionomer or
self-adhesive resin cement. (Art & Science, p. 508)
 MDP-based resin cements → ↑ adhesion to zirconia.
 Sandblasting is controversial.
 There is a definite risk in the use of air particle abrasion, why?
(Give reason)
→ conversion to monoclinic & substantial weakening.
 Air abrasion with alumina, followed by MDP-based self-adhesive
resin cements → form stable Zr–O–P bonds on the zirconia
surface & improve its bond strength. (Craig, p. 281,282)
 Tribochemical coating using silica-modified alumina particles,
followed by silanization is also efficient. (Craig, p. 281)
 The combination of mechanical and chemical pretreatment is
recommended for bonding to zirconia. (Art & Science, p. 158)
A note on zirconia restorations
 Try-in → contamination with saliva.
 Zirconia has a strong affinity for proteins found in saliva & blood.
 These proteins cannot be removed with phosphoric acid.
 NaOH solution (Ivoclean, Ivoclar Vivadent), for 20 seconds, remove these
proteins. (Art & science p. 508)

20

21
Resin-to-metal bonding (briefly)
 MDP & 4-META: the metal oxides on the surface of base metal & tin-plated
noble alloys contributes to the bond strength (chemical bond) when resin
cements contain MDP or 4-META. (Phillips)
 Tin plating improves the retention of noble alloys, why? (Give reason)
 Noble alloys → lack of metal oxide on the surface.
 Tin plating → tin can form tin oxide on the surface.
 Metals are best prepared by sandblasting (airborne-particle abrasion) with
alumina particles
 ↑ retention by 64%. (Contemporary, p. 781)
 Creates a roughened higher surface area for bonding.
 Alumina coating → aids in oxide bonding of Phosphate-based adhesive
system. (Contemporary, p. 697)
 Tribochemical silica coating (blasting with silica-coated alumina particles),
followed by silane application is adequate.
 However, it is generally confined to bonding composite resin veneers to
alloy castings, why? (Give reason)
 Because the silane-treated surface may become contaminated
before or during the clinical bonding procedures.
(Contemporary, p. 698)
 Types: (Introduction to dental materials, p. 227)
 Rocatec: laboratory-based system
 Cojet: chair-side system
 Disadvantages: (Introduction to dental materials, p. 228)
 Multiple steps → ↑ likelihood of errors.
 Need special equipment.
 Metal primers are developed, but the research results are inconsistent.
(Craig, 280)

22
 Electrolytic etching is not popular, why? (Give reason)
 Requires high degree of skill & special equipments.
 Note: alloy etching and macroscopic retention mechanisms have become
obsolete. (Contemporary, p. 697)
Resin-to-resin bonding
 Introduction: (Introduction to dental materials, p. 229)
 One might imagine that resin-to-resin bonding should be free of
problems, this is, in fact, not the case.
 In particular, there have been problems of debonding between the luting
resin & composite inlay.
 Oxygen inhibition layer does not exist.
 The luting resin has to bond directly to fully cured resins.
 This is similar to repairing a fractured composite restoration with
new composite resin.
 Roughened by grit-blasting (alumina sandlasting).
 Phosphoric acid etching → clean the debris from the surface.
 HF acid is not recommended, why? (Give reason)
 HF causes degradation of the composite surface by etching away the
silica glass → leaving a weak & porous polymer matrix. (Craig, p. 282)
 Tribochemical technique → silica layer, then silane application.
 The problem of resin-to-resin bonding has not yet been resolved satisfactorily,
& thus will continue to be an area of research interest.

23
A note on “try-in” pastes (Craig & Phillips)
 Same shade as the resin cement.
 Help with shade selection.
 Glycerin-based.
 Water-soluble.
 After shade selection → rinsed away with water spray.
A note on temporary cementation
 Eugenol-free interim (temporary) luting agent should be used, why?
(Give reason)
 Because eugenol inhibits polymerization of the resin.
References
Sakaguchi R, Ferracane J, Powers J. Craig's restorative dental materials. 14th
ed.
St. Louis, Elsevier; 2019. p. 280–282, 289–292.
Ritter AV, Boushell LW, Walter R. Sturdevant's art and science of operative
dentistry. 7th
ed. St. Louis, Elsevier; 2019. p. 157–159, 297, 443, 482, 508.
Rosenstiel SF, Land MF, Fujimoto J. Contemporary fixed prosthodontics. 5th
ed.
St. Louis, Elsevier; 2016. p. 691, 696–698, 708, 777–781, 784.
Van Noort R, Barbour ME. Introduction to dental materials. 4th
ed. Mosby
Elsevier; 2013. p. 221–229.
Anusavice KJ, Shen C, Rawls HR. Phillips' science of dental materials. 12th
ed. St.
Louis, Elsevier; 2013. p. 311, 329, 330.

Resin Luting Cements (2nd edition) pdf

More Related Content

What's hot

Similar to Resin Luting Cements (2nd edition) pdf

More from Ahmed Mostafa Hussein Mohammed

Recently uploaded

In this document

Resin Luting Cements (2nd edition) pdf