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Dental Cements: An Update

Derek W. Jones, PhD, FIM, C.Chem. FRSC(UK), FBSE

In my dental office, we use about 10 different types of dental cement. Which cements are best suited for which application and which cements are most popular?

Dr. Jones Reply | Some Important Points To Remember | Potential Pitfalls | What Cements Are Most Popular? | Editor's Note |

Dr. Jones Reply:

The proliferation of cement materials on the market in the past few years can be confusing for the practicing dentist. You point out that you may have as many as 10 different types of cement in your dental office. Perhaps, this is as it should be, as no one material has all of the properties required for every clinical application.

Three International Standards Organization (ISO) classifications have been specified for the use of dental cements: I) luting applications; II) restorative applications; and III) liner or base applications. Some types of cements are supplied in more than one of these three classifications. Selection of cements for particular applications requires knowledge of the chemistry and physical properties of the particular cement type.

The following are examples of the use of various types of cement.

Cement Systems Principally Used For Luting Comprise: Zinc Phosphate, Zinc Polycarboxylate, Polyalkenoate (Glass Ionomer) Resin Cement, (especially orthodontic appliances) Resin Filled cement, Resin Ionomer Cement (resin modified ionomer).
Cement Used For Temporary Luting Or Temporary Restoration: Zinc oxide-eugenol, Zinc Oxide EBA (ethoxy benzoic acid).
Pulp Capping and Thermal-Insulating Base: Calcium hydroxide, Zinc oxide-eugenol.
Cavity Liners and Bases: Glass ionomer and resin-modified glass ionomer, Polycarboxylate, Zinc oxide-eugenol.
Cementing Veneers and Composite Inlays: Resin cements. Root Canal Sealants and Periodontal Dressing: Zinc oxide-eugenol.
Core Buildup Under a Crown Or Bridge Preparation: Metal-modified glass-ionomer.

Table I lists the names of some commonly used dental cements.

 Table I
 Some Trade Names Of Various Dental Cements commonly Used In Practice
Glass Ionomer Resin Modified Ionomer Resin Cement Chemically Cured Resin Cement Dual Cured Zinc Phosphate Zinc Poly- carboxylate Zinc Oxide-Eugenol
Fuji (GC) Advance (Caulk) Panavia 21 (J. Morita) Resinomer (Bisco) Tenacin (Caulk) Durelon (ESPE) Tem-Bond (Kerr)
Ketac-Cem (ESPE) Vitremer Luting (3M) Clearfil CR Inlay (J. Morita) Enforce (Dentsply) Fleck’s (Mizzy) Tylok Plus (Caulk) Fynal (Caulk)

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Some Important Points To Remember:

• Only those cements which make use of polyacrylic acid, such as zinc polycarboxylate and glass polyalkenoate (glass ionomer), are capable of providing the carboxylate groups that have chemical adhesion to tooth structure.
• Zinc oxide-eugenol cements can have a detrimental effect on the setting of some resin systems used in composite materials and have the potential to contaminate tooth surface prior to using bonding agents.
• Glass ionomer cements are unfortunately sensitive to moisture immediately following mixing and during setting. Paradoxically, glass ionomer cements are best placed on moist tooth structure, excessive drying of the preparation is not recommended.
• Conventional glass ionomer cements are very important in geriatric dentistry due to the fact that they can release fluoride and can chemically bond to tooth structure. This is particularly valuable in erosion cavities and root caries situations.
• Resin modified glass ionomer cements generally have a much lower release of fluoride than the conventional glass ionomer materials.
• Creep of cements (continuous permanent deformation under a static force) can be detrimental to the performance of cements in certain clinical situations. The relatively high creep of zinc polycarboxylate cements may not be acceptable for certain fixed orthodontic appliances or for large (long-span) bridge structures.
• All “conventional” cements have similar low fracture toughness. However, conventional glass ionomer cements are generally stronger than zinc polycarboxylate cements. In contrast, the resin (BISGMA or urethane acrylate) and the resin-modified glass ionomer cements are both tougher and stronger than conventional cements.
• Manipulation of the cement is very important. Variations in the powder/liquid ratio can influence the working and setting time, the consistency and flow, as well as the degree of solubility, erosion, strength and film thickness.

Several cements are now being supplied in capsules containing the preproportioned powder and liquid. This system is very convenient and ensures consistent powder/liquid ratios. However, it does take away the flexibility of being able to vary the consistency of the mixed cement to suit specific applications. It also does not provide the latitude for controlling the amount of mixed cement. In addition, small changes in the time of mechanical mixing with the amalgamator can significantly influence the setting of the cement.

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Potential Pitfalls

A large number of factors may influence the performance of luting cements. Cementing errors occur due to a range of possible influences such as: incorporating too much or too little powder; premature exposure of the cement to moisture; delay between completion of the mix and seating; room or mixing slab temperature is too high; surface contamination of casting or preparation.

To avoid premature setting of the cement, apply the cement first to the appliance at room temperature and then to the preparation at mouth temperature. The elevated mouth temperature accelerates the setting of the cement. Cementing problems can occur such as: seating difficulty; loosening of appliances; excessive solubility and disintegration; or too short a working time.

One method which can aid in the seating of appliances during cementation, is the use of vibration, as well as stress. Careful attention to the above details are required in order to avoid errors in cementation. Another consideration for larger bridge structures is the question of working time. The zinc phosphate cements have relatively longer setting time especially when mixed on a cool glass slab.

Interestingly, an evaluation of zinc phosphate cements found them to give a lower film thickness at three minutes compared to earlier times of testing at one, 1.5, two, and 2.5 minutes. The simple explanation being, that the particle size of the zinc oxide powder is reduced with time during the reaction with the acid, and the viscosity changes due to the setting reaction. This allows for a thinner film at three minutes.

I always remind my students, with tongue in cheek, that when all else fails, they should read the instructions. It is extremely important to read the instructions for all the dental materials we use. Keep the instructions with the particular batch of material. From time-to-time, manufacturers may make changes to the instructions, thus with each new package you should read the instructions again to be on the safe side. Follow the manufacturer’s instructions for storage and mixing of the material.

Always dispense the powder first, before the liquid, to minimize the loss of water due to evaporation. Always hold the bottle or vial upright to ensure consistent sized drops when dispensing liquid. Be sure to fluff up the powder in the bottle prior to using the dispensing measuring scoop. Remember, for many cements it can be beneficial to cool the glass slab in the refrigerator prior to mixing, to slow down the reaction rate and increase the working time.

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What Cements Are Most Popular?

There may not be a simple answer to this question, since it very much depends on the type of dental practice you operate. For the permanent cementation of crowns, glass ionomer cements may be the most popular with polycarboxylate and zinc phosphate placed second and third. For bridges, glass ionomer and zinc phosphate are among the most commonly used. The greater rigidity of these cements and lower creep, is particularly beneficial in long span bridges. Conclusion The dentist of 1998 has an excellent range of dental cements available to apply to a wide range of clinical situations. Dentists can rest assured that the zinc phosphate and zinc oxide-eugenol cements which were in use during dental school days are still valuable and very necessary materials in the armamentarium of a busy general dental practice.

Dr. Jones is professor of biomaterials, at Dalhousie University, Halifax, Nova Scotia. The author has no declared financial interest in any company manufacturing the types of products mentioned in this article.

Editor's note:

I invite readers to send me questions about clinical problems experienced in everyday practice. I will seek answers to these questions from recognized Canadian experts. You can send me your questions by e-mail, fax or regular mail. I look forward to hearing from you.

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