Classification of the Luting Materials: Comparison
View Latest Version
Please note this is a comparison between Version 2 by Conner Chen and Version 1 by Gary Kwun-Hong Leung.

A dental luting material aids in the retention and stability of indirect restorations on the prepared tooth structure. The luting materials can generally be classified by their chemical compositions, bonding mechanisms or clinical indications.

  • indirect restoration
  • luting agents
  • luting cements

1. Introduction

A luting cement is a material that is used to attach indirect restorations to prepared tooth surfaces by filling minute voids between the restorations and the tooth structures, thereby locking the restoration mechanically to prevent dislodgement [1,2][1][2]. A luting material provides the retention of indirect restorations by providing mechanical interlocking, chemical bonding or both of them. Traditional cementation rely mostly on the frictional forces between the prepared tooth surfaces and fitting walls of restorations [3]. More contemporary materials utilize chemical and micromechanical adhesion to bond between the tooth surface, cement and restorative material [4].
Understanding the properties of the luting materials and their clinical indications is helpful to ensure the quality of the cementation. The luting materials create the seal between the restoration and the tooth. A good seal is important not only to hold the restoration in place but also to make the surface impervious to microleakage and caries. Hence, luting materials affect the longevity of indirect restorations. In addition, the luting materials are widely indicated in the cementation of crowns, inlays, onlays, veneers, multiple-unit fixed prostheses, endodontic posts and orthodontic appliances. It is essential for dental practitioners to comprehend the clinical indications of the common luting materials.

2. Historical Development of Common Luting Cements

Over the past 50 years, a range of new materials has been developed which are known as luting cements. However, before this period, zinc phosphate had been the only choice of material for permanent cement for almost 100 years since the late 19th century. Therefore, it is often regarded as the “gold standard” for permanent dental cements [5]. In the late 1960s, zinc polycarboxylate was introduced, which offered more options of luting material to clinicians at that time [3]. Contemporary cements shifted from the utilization of a bonding mechanism to luting (filling in the space between the tooth and the restoration). Between the 1970s and the 1980s, glass ionomer cement (GIC) and resin-modified glass ionomer cement (RMGIC) was invented. Resin cement, which was invented in the 1950s, has undergone many reformulations and improvements over the years. Owing to the increasing demand for aesthetic all-ceramic restorations, it has gained high popularity in contemporary dentistry [5]. In the 2000s, self-adhesive resin cement was developed to simplify the clinical procedure of traditional resin cements [6]. Calcium aluminate/glass ionomer cement (CaAl/GI) has a bioactivity property by creating hydroxyapatite crystals, and this was introduced in 2009 [7,8,9][7][8][9]. An ideal luting cement should be biocompatible, insoluble, resistant to thermal and chemical assaults, antibacterial, aesthetic, simple and easy to use. It should have high strength properties under tension, shear and compression to resist the stress at the restoration–tooth interface, as well as adequate working and setting times. So far, no luting material possesses all of these properties of an ideal cement.

3. Classification of the Luting Materials

The luting materials can generally be classified by their chemical compositions, bonding mechanisms or clinical indications. Luting materials can be classified as water- or resin-based luting cements based on their chemical composition. Water-based materials include zinc-oxide eugenol and non-eugenol, zinc polycarboxylate, zinc phosphate, GIC and hybrid CaAl/GI cements. Resin-based luting cements include conventional and self-adhesive resin cements. RMGIC, which has the properties of GIC and resin cements, is a mix of water- and resin-based cement. Luting materials can also be classified as non-adhesive, chemically adhesive and micromechanically adhesive luting agents by means of a bonding mechanism. Non-adhesive luting materials achieve restoration by friction only. Chemically adhesive luting materials can establish molecular interactions with the tooth structures to form chemical bonding, whereas micromechanically adhesive materials accomplish adhesion via micromechanical interlocking between the adhesive and the tooth surfaces [10]. Non-adhesive cements include zinc oxide eugenol and non-eugenol and zinc phosphate cements. Chemically adhesive materials include zinc polycarboxylate, GIC and hybrid CaAl/GI cements. Both types of resin cement are micromechanically adhesive materials. RMGIC can be both chemically adhesive and micromechanically adhesive. Based on the clinical indication, luting materials can be categorized into temporary or permanent cements. Temporary cements are used to retain provisional restorations, and these include zinc oxide eugenol and non-eugenol and zinc polycarboxylate [11] (Table 1).
Table 1.
Properties and the types of temporary luting cements.
Properties Ideal Materials [12] Zinc Oxide Eugenol
).
Table 2.
Properties and permanent luting cements.
Properties Ideal Material

[4]		Zinc Oxide Non-Eugenol Zinc Polycarboxylate
Zinc Phosphate Zinc Poly-Carboxylate GIC RMGIC Hybrid CaAl/GIC Conventional Resin Cement Self-Adhesive Resin Cement
Bond strength Low

(for easy of removal)		 Low
Compressive strength (MPa)

[20,		Low 21]Compressive strength (MPa)

[20][21]		 High 48

(Flecks)		 63Low


(Durelon) 105

(Ketac Cem) 96.3

(RelyX Luting)		 160

(Ceramir C&B)		 209

(Scotchbond resin cement)

(RelyX Unicem)		 Handling properties

[13]		 Good Good Good Fair

(cement is hard to mix)
157
Elastic modulus (GPa) [21,22]Elastic modulus (GPa) [21][22] 13.7

(dentine)		 19.8 (Flecks) 16.1 (Durelon) 19.5

(Ketac Cem)		 6.8

(Vitremer)		 No data 11.8 (Scotchbond resin cement) 16.5

(RelyX Unicem)		 Ease of cleaning up

[13,14]		Ease of cleaning up

[13][14]		 High High High
Shear bond strength 1 (MPa) [9,23,24] (MPa) [9][23][Low

(cement is hard to remove)
24] High 0.65

(N.A.)		 1.40

(N.A.)		 2.36

(GC Fuji 9)		 2.53

(GC Fuji Plus)		 5.79 2

(Ceramir C&B)		 6.99

(Panavia F 2.0)		 5.07

(Clearfil SA)		 Effect on permanent cementation

[15,16,17]		Effect on permanent cementation

[15][16][17]		 No adverse effect Interfere resin cement No adverse effect
Fluoride releaseNo adverse effect
Yes No No Yes Yes Yes No Yes Pulpal effect

[13,18,19]		Pulpal effect

[13][18][19]
Microleakage

[12,25,26,27]		Microleakage

[12][25][26		Minimal pulpal irritation

Sedative		 Anti-inflammatory anaesthetic Minimal pulpal irritation Minimal pulpal irritation
The permanent cements include zinc phosphate, zinc polycarboxylate, GIC, RMGIC, conventional and self-adhesive resin cement and hybrid CaAl/GI cement. They are used in the cementation of definitive restorations (Table 2
]
[
27
]
Minimal High High to very high Low to very high Very low Low to high Very low Very low
Film thickness (µm)

[12,20,28,29,30,31]		Film thickness (µm)

[12][20][28][29][30][31]		 Thin <25

(N.A.)		 <25

(N.A.)		 24.2

(GC luting)		 25.2

(GC Fuji Plus)		 16.4

(Ceramir C&B)		 24.3

(Panavia 21)		 16.0

(RelyX Unicem)
Working time (min)

[12,31,32,33,34]		Working time (min)

[12][31][32][33][34]		 Long ~2:30

(DeTrey Zinc)		 2:00–2:30 (Poly-F Plus) 3:10

(Ketac Cem)		 2:30

(GC Fuji Plus)		 2:00

(Ceramir C&B)		 4:00

(Panavia 21)		 2:30

(RelyX Unicem)
Setting time (min)

[20,31,32,33,34]		Setting time (min)

[20][31][32][33][34]		 Short 5:00–6:00 (DeTrey Zinc) 5:00–7:00 (Poly-F Plus) 7:00

(Ketac Cem)		 4:30

(GC Fuji Plus)		 ~4:48

(Ceramir C&B)		 7:00

(Panavia 21)		 6:00

(RelyX Unicem)
Removal of excess

[9,12]		Removal of excess

[9][12]		 Easy Easy Medium Medium Medium Easy Difficult Medium
Water solubility

[12]		 Minimal High High Low Very low Low Very low Very low
Aesthetics High Low Low Low Moderate Low Highest High
Color stability High Low Low Low Moderate Low Highest High
Pulpal irritation [12] Low Moderate Low High High No data High High
1: Values based on studies of cementation of zirconia onto dentine. 2: Not tested under universal setting. GIC—Glass ionomer cement; RMGIC—Resin-modified glass ionomer cement; Hybrid CaAl/GIC; Hybrid calcium aluminate/glass ionomer cement.

References

  1. Driscoll, C.F.; Freilich, M.A.; Guckes, A.D.; Knoernschild, K.L.; Mcgarry, T.J.; Goldstein, G.; Goodacre, C.; Guckes, A.; Mor, S.; Rosenstiel, S.; et al. The glossary of prosthodontic terms: Ninth edition. J. Prosthet. Dent. 2017, 117, e1–e105.
  2. Hill, E.E.; Lott, J. A clinically focused discussion of luting materials. Aust. Dent. J. 2011, 56 (Suppl. 1), 67–76.
  3. Segarra, M.; Segarra, A. The evolution of cements for indirect restorations from luting to bonding. In A Practical Clinical Guide to Resin Cements; Springer: Berlin/Heidelberg, Germany, 2015; pp. 3–7.
  4. Wingo, K. A review of dental cements. J. Vet. Dent. 2018, 35, 18–27.
  5. Hill, E.E. Dental cements for definitive luting: A review and practical clinical considerations. Dent. Clin. N. Am. 2007, 51, 643–658.
  6. Sakaguchi, R.L.; Powers, J.M. Craig’s Restorative Dental Materials; Elsevier: St Louis, MO, USA, 2011.
  7. Lööf, J.; Svahn, F.; Jarmar, T.; Engqvist, H.; Pameijer, C.H. A comparative study of the bioactivity of three materials for dental applications. Dent. Mater. 2008, 24, 653–659.
  8. Pameijer, C.H. A review of luting agents. Int. J. Dent. 2012, 2012, 752861.
  9. Acharya, R.P.; Morgano, S.M.; Luke, A.C.; Ehrenberg, D.; Weiner, S. Retentive strength and marginal discrepancies of a ceramic-reinforced calcium phosphate luting agent: An in vitro pilot study. J. Prosthet. Dent. 2018, 120, 771–779.
  10. Craig, R.G. Restorative Dental Materials, 8th ed.; Mosby: St. Louis, MO, USA, 1989.
  11. Wassell, R.W.; St. George, G.; Ingledew, R.P.; Steele, J.G. Crowns and other extra-coronal restorations: Provisional restorations. Br. Dent. J. 2002, 192, 619–630.
  12. Rosenstiel, S.F.; Land, M.F.; Crispin, B.J. Dental luting agents: A review of the current literature. J. Prosthet. Dent. 1998, 80, 280–301.
  13. Stephen, F.R.; Martin, F.L.; Junhei, F. Contemporary Fixed Prosthodontics—E-Book, 4th ed.; Mosby: St. Louis, MO, USA, 2006.
  14. Sakaguchi, R.L.; Ferracane, J.L.; Powers, J.M. Craig’s Restorative Dental Materials, 14th ed.; Elsevier: St. Louis, MO, USA, 2019.
  15. Ribeiro, J.C.; Coelho, P.G.; Janal, M.N.; Silva, N.R.; Monteiro, A.J.; Fernandes, C.A. The influence of temporary cements on dental adhesive systems for luting cementation. J. Dent. 2011, 39, 255–262.
  16. Sabouhi, M.; Nosouhian, S.; Davoudi, A.; Nourbakhshian, F.; Badrian, H.; Nabe, F.N. The effect of eugenol-free temporary cement’s remnants on retention of full metal crowns: Comparative study. J. Contemp. Dent. Pract. 2013, 14, 473–477.
  17. Kanakuri, K.; Kawamoto, Y.; Matsumura, H. Influence of temporary cement remnant and surface cleaning method on bond strength to dentin of a composite luting system. J. Oral Sci. 2005, 47, 9–13.
  18. Markowitz, K.; Moynihan, M.; Liu, M.; Kim, S. Biologic properties of eugenol and zinc oxide-eugenol. A clinically oriented review. Oral Surg. Oral Med. Oral Pathol. 1992, 73, 729–737.
  19. Kwon, J.S.; Illeperuma, R.P.; Kim, J.; Kim, K.M.; Kim, K.N. Cytotoxicity evaluation of zinc oxide-eugenol and non-eugenol cements using different fibroblast cell lines. Acta Odontol. Scand. 2014, 72, 64–70.
  20. Jefferies, S.; Lööf, J.; Pameijer, C.H.; Boston, D.; Galbraith, C.; Hermansson, L. Physical properties and comparative strength of a bioactive luting cement. Compend. Contin. Educ. Dent. 2013, 34, 8–14.
  21. Li a, Z.C.; White, S.N. Mechanical properties of dental luting cements. J. Prosthet. Dent. 1999, 81, 597–609.
  22. Saskalauskaite, E.; Tam, L.E.; McComb, D. Flexural strength, elastic modulus, and pH profile of self-etch resin luting cements. J. Prosthodont. 2008, 17, 262–268.
  23. Prylinska-Czyzewska, A.; Piotrowski, P.; Prylinski, M.; Dorocka-Bobkowska, B. Various cements and their effects on bond strength of zirconia ceramic to enamel and dentin. Int. J. Prosthodont. 2015, 28, 279–281.
  24. Nanavati, K.; Katge, F.; Chimata, V.K.; Pradhan, D.; Kamble, A.; Patil, D. Comparative evaluation of shear bond strength of bioactive restorative material, zirconia reinforced glass ionomer cement and conventional glass ionomer cement to the dentinal surface of primary molars: An in vitro study. J. Dent. (Shiraz) 2021, 22, 260–266.
  25. Ebadian, B.; Fathi, A.; Savoj, M. In Vitro evaluation of the effect of different luting cements and tooth preparation angle on the microleakage of zirconia crowns. Int. J. Dent. 2021, 2021, 8461579.
  26. Pameijer, C.H.; Zmener, O.; Alvarez Serrano, S.; Garcia-Godoy, F. Sealing properties of a calcium aluminate luting agent. Am. J. Dent. 2010, 23, 121–124.
  27. Al-Saleh, S.; Aboghosh, T.W.; Hazazi, M.S.; Binsaeed, K.A.; Almuhaisen, A.M.; Tulbah, H.I.; Al-Qahtani, A.S.; Shabib, S.; Binhasan, M.; Vohra, F.; et al. Polymer-based bioactive luting agents for cementation of all-ceramic crowns: An SEM, EDX, microleakage, fracture strength, and color stability study. Polymers 2021, 13, 4227.
  28. Sulaiman, T.A.; Abdulmajeed, A.A.; Altitinchi, A.; Ahmed, S.N.; Donovan, T.E. Physical properties, film thickness, and bond strengths of resin-modified glass ionomer cements according to their delivery method. J. Prosthodont. 2019, 28, 85–90.
  29. Kumar, M.P.; Priyadarshini, R.; Kumar, Y.M.; Priya, K.S.; Chunchuvyshnavi, C.; Yerrapragada, H. Effect of temperature on film thickness of two types of commonly used luting cements. J. Contemp. Dent. Pract. 2017, 18, 1159–1163.
  30. Bagheri, R. Film thickness and flow properties of resin-based cements at different temperatures. J. Dent. (Shiraz) 2013, 14, 57–63.
  31. Kious, A.R.; Roberts, H.W.; Brackett, W.W. Film thicknesses of recently introduced luting cements. J. Prosthet. Dent. 2009, 101, 189–192.
  32. DeTrey Zinc Directions for Use. Available online: http://www.dentsply.de/bausteine.net/file/showfile.aspx?downdaid=7695&sp=D&domid=1042&fd=2 (accessed on 4 August 2022).
  33. Technical Product Profile Ketac Cem. Available online: https://multimedia.3m.com/mws/media/157473O/3m-ketac-cem-glass-ionomer-cement-technical-product-profile.pdf (accessed on 4 August 2022).
  34. GC Fuji Plus Instructions for Use. Available online: https://www.gcamerica.com/products/operatory/GC_Fuji_PLUS/GC_Fuji_PLUS_10IFU.pdf (accessed on 5 August 2022).
More
© Text is available under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/)
ScholarVision Creations
Feedback