Luting agents used in prosthodontics

PRESENTED BY
DR ARUN KUMAR C S

First used dental cement- silicate cement
1871- Silicate cements (Fletcher)
1879- Zinc phosphate cements (Otto Hoffman)
1942- Zinc oxide eugenol (Chrisholm)
1947- Methyl methacrylate resins
1960- Composites
1972- Glass Ionomers (Wilson & Kent)

 Cement - Substance that hardens to act as a base, liner, filling
material, or adhesive to bind devices and prostheses to tooth
structure or to each other. (Anusavice 11th)
 Cementation - attaching a restoration to natural teeth by means of a
cement . (GPT-9).
 Luting agent - any material used to attach or cement indirect
restorations to prepared teeth. (GPT-9)

REQUIREMENTS OF LUTING CEMENTS
 Adhesion to restorative material
 Adequate strength to resist functional forces
 Lack of solubility in oral fluids
 Low-film thickness
 Biocompatibility with oral tissues
Jivraj SA, Kim TH, Donovan TE. Selection of luting agents, part 1. J Calif Dent Assoc. 2006 Feb;34(2):149-60

 Possession of anticariogenic properties
 Radio-opaque
 Relative ease of manipulation
 Esthestic/color stability
Jivraj SA, Kim TH, Donovan TE. Selection of luting agents, part 1. J Calif Dent Assoc. 2006 Feb;34(2):149-60

WATER BASED
GIC , Resin Modified Glass Ionomer Zinc
Polycarboxylate
Zinc Phosphate
OIL BASED
Zinc oxide eugenol Non-
eugenol Zinc oxide
RESIN BASED
Composite and Adhesive Resins
Compomer
• Based on the INGREDIENTS
Kenneth J.A -Philip’s science of dental materials- 11th edition.

• According to Craig:
Functions Cements
Final cementation of completed restorations ZnPO4, zinc silicophosphates
Reinforced ZOE,Zinc poly carboxylate ,GIC
Temporary cementation of completed
restorations/cementation of temporary restorations
ZOE,Non eugenol zinc oxide
High strength bases ZnPO4, Reinforced ZOE, Zinc
poly carboxylate, GIC
Temporary fillings ZOE, Reinforced ZOE, Zinc poly
carboxylate
Low strength bases ZOE, Ca(OH) 2
Liners Ca(OH) 2 in asuspension
Varnishes Resin in a solvent
Craig RO -Restorative dental materials- 11th edition

• According to O’Brien (by Matrix type):
PHOSPHATE
Zinc Phosphate
Zinc Silico phosphate
PHENOLATE
Zinc oxide eugenol
Calcium Hydroxide Salicylate
POLYCARBOXYLATE
Zinc Polycarboxylate
Glass Ionomer
RESIN
Polymethy Methacrylate
Dimethyl Methacrylate
Adhesive
RESIN MODIFIED GLASS IONOMER
Hybrid Ionomer
Brien WJ -Dental materials and their selection- 3rd edition

By Schillinburg
• Non-Adhesive:
• Cement fills the restoration-tooth gap and holds by engaging in
small surface irregularities.
• Micromechanical Bonding:
• Surface irregularities are enhanced by air abrasion or acid
etching
• Improves the frictional retention.
• Molecular Bonding:
• Chemical bond formation between cement and the tooth
structure.

• Introduced by Dr. Otto Hoffman during the 1800s
• One of the oldest cement
• Acts as the gold standard by which newer materials are compared.
APPLICATION
• Luting of restorations(Cast crown,procelain fused crown,
cast post and crown.)
• Luting of orthodontic bands

POWDER % Function
ZnO 90.2% Principle ingredient
MgO 8.2% Reduce temperature of calcination process
SiO2 1.4% Improves the working characteristics
Bi2O3 0.1% Smoothness of mix &lengthen working time
BaO, Ba2SO4 &
CaO
0.1%
LIQUID
H3 PO4 38.2% Reacts with ZnO
Al 2.5% Essential for cement forming reaction
Zn 7.1% Moderator for reaction between powder& liquid,
allows adequate working time
H20 36% Controls the rate of reation

• A-B
• Aluminium forms complexes with
phosphoric acid, reacts with zinc forming
zinc aluminophosphate gel.
• Exothermic reaction.
• Low pH 3.5
• Copalite
Felton DA, Kanoy BE, White JT. Effect of cavity varnish on retention of cemented cast crowns. J Prosthet Dent. 1987 Apr;57(4):411-6

Frozen Glass slab Technique:
• To prolong working time and shorten setting time.
• Glass slab cooled at 6°C or – 10°C.
• 50 – 75% more powder incorporation.
• Working time is increased by 4 – 11 mins
• Setting time shortened by 20 – 40%
Mixing time 1.5 – 2mins (Phillips)
Working time 5mins (Phillips)
Setting time 5-9mins (Craig)
5-14mins (O’Brien)
Film thickness 20µm

This cement retains the prosthesis purely by mechanical means.
Taper, length and surface area of the tooth preparation are
therefore critical to its success.
De Baker reports that alloy based restorations luted with this
cement had a 20-years survival rate .
Oilo G, Jorgensen KD (1978) The influence of surface roughnessin the retentive ability of two dental luting cements. J Oral
Rehabil 5:377–389
DeBacker H, Van Maele G, DeMoor N, Van den Berghe L, DeBoever J. A 20-year retrospective survival study of fixed partial
dentures. Int J Prosthodont 2006;19:143–53

INDICATIONS
 Cast crown,procelain fused crown, cast post .
 Ceramic inlay, ceramic veneer, resin bonded FPD.
Diaz-Arnold AM, Vargas MA, Haselton DR. Current status of luting agents for fixed prosthodontics. J Prosthet Dent.
1999 Feb;81(2):135-41.
CONTRAINDICATIONS

Advantages
Strength to maintain the restoration .
Mixed easily and set sharply.
Disadvantages
Irritating effect on the pulp .
Lack of anticariogenic properties .
Lack of adhesion to the tooth .

MODIFIED ZINC PHOSPHATE CEMENT
COPPER & SILVER CEMENTS
• Black copper cements : Cupric oxide
• Red copper cements : Cuprous oxide
• copper varies between 2% and 97%.
• Lower P:L ratio Highly acidic
• Higher solubility
• Lower strength than ZnPO4
• Silver cements : contain small percentage of salts of silver phosphate
Timothy WF (1916) The Dental Review. Our present cements with special
reference to those containing copper, vol XXX, No. 8, Chicago, pp 691–704

• Stannous fluoride (1-3%)
• Higher solubility and lower strength – due to dissolution
of Fluoride
• Fluoride uptake by enamel : Reduced enamel solubility and
Anticariogenic

ADVANTAGE
• Cast silver cap splints-in facial fractures
• Deciduous teeth
DISADVANTAGE
• Toxic
• Discolouration
McCabe JF, Walls AWG (2005) Applied dental materials, 8thedn. Blackwell Pub. Co, Oxford, pp 226–230

• Dennis Smith : 1968
• First cement system with adhesive bond to tooth
structure A-B
• Also known as polyacrylate cement
APPLICATION
• Luting alloy restorations
• Cementing orthodontic bands
• Cementing SS crown in pediatric dentistry

POWDER %
ZnO
SnO / MgO 1 – 5
Aluminium oxide 10 – 40
Stannous Fluoride : Modified setting time
LIQUID
40% Aqueous solution of Polyacrylic Acid

SETTING REACTION
• Powder particles are attacked by the acid releasing Zn, Mg, Sn ions.
• Ions bind to the polymer chain via the carboxyl groups.
• Ions also react with carboxyl group of adjacent polyacid chains to form
cross linked salts.
• Mixed rapidly in 30 – 40 secs
• Working time : 2.5 – 3.5 mins
• Setting time : 6-9mins (at 37°C)

PROPERTIES
• Solubility in water is low
• In organic acid with pH < 4.5 : increased solubility
• Reduced P:L ratio : increases solubility in oral cavity
Film Thickness 25 µm
Compressive Strength 55 - 85 Mpa
Tensile Strength 8 - 12 Mpa
Modulus of elasticity 6 Gpa
Bond strength to enamel 3.4 – 4.7 Mpa
Bond strength to dentin 2.1 Mpa
Thermal diffusivity 0.223mm2/sec

Mechanism of retention(Adhesive.)
• Polyacrylic acid reacts with Calcium ions via the carboxyl groups on the
surface of enamel and dentin.
• Weak bond with gold.
• No perceptible bond with porcelain.
• Bond with the non-precious alloys - oxide layer.
Ladha K, Verma M. Conventional and contemporary luting cements: an overview.
J Indian Prosthodont Soc. 2010 Jun;10(2):79-88

Zinc polycarboxylate cement had highest mean retention in
implant supported prosthesis
Bond strength of polycarboxylate cement for metal–metal
adhesion(Jendresen and Trowbridge).
According to Wilson and Paddon the cement remains less
brittle and is tougher than silicate, zinc phosphate and glass
ionomer cement.
Wilson AD, Paddon JM, Crisp S. The hydration of dental cements. J Dent Res. 1979 Mar;58(3):1065-71
Garg P, Pujari M, Prithviraj DR, Khare S. Retentiveness of various luting agents used with implant-supported prosthesis
: an in vitro study. J Oral Implantol. 2014 Dec;40(6):649-54.

 Cast crown.
 PFM crown.
 patient with previous history of sensitivity .
 Pressed ceramic crown, ceramic inlay. ceramic veneer.
 Resin bonded FPD.
 Cast post and core.
 Crown or FPD with poor retention.
Diaz-Arnold AM, Vargas MA, Haselton DR. Current status of luting agents for fixed prosthodontics. J Prosthet
Dent. 1999 Feb;81(2):135-41.
Contraindications
Indications

ADVANTAGES DISADVANTAGES
Low irritation Lower compressive strength
Chemical bond to tooth structure
and alloys
Greater viscoelasticity
Easy manipulation Need for clean surfaces for adhesion
Adequate strength Short working time
Low solubility
Adequate film thickness
Anticariogenic
Charlton DG, Moore BK, Swartz ML (1991) Direct surface pH determination of
setting cements. Oper Dent 16:231–238

This material has been used to a wide range
Provisional luting cements.
Provides an excellent seal against leakage.
Types (Acc to ADA spec 30)
Type I –temporary cementation
Type II –permanent cementation of restorations
Type III –temporary restoration and thermal insulating bases
Type IV – cavity liner

COMPOSITION
POWDER % Function
ZnO 69 Principal component
White rosin 29.3 Reduce brittleness of the cement
Zinc stearate 1 Accelerator, plasticizer
Zinc acetate 0.7 Improves strength of the cement
Silica Filler
LIQUID
Eugenol / oil of cloves 85
Olive oil 15 Plasticizer

• Hydrolysis of the ZnO
ZnO + H2O Zn(OH)2
Zn(OH)2 +2HE ZnE2 + 2H20
• Zinc hydroxide reacts with acid eugenol forming zinc eugenolate A-B
• Set cement zinc oxide embedded in a matrix of zinc eugenolate
• Reaction is reversible, zinc eugenolate can easily be hydrolysed by moisture
in the oral cavity to eugenol and zinc hydroxide

Obtundant effect on pulpal tissues Low strength and low
abrasion resistance
Good sealing ability Disintegration in oral fluids
Resistance to marginal penetration Less anticariogenic
Good thermal insulation Solubility is highest among all cements
Ladha K, Verma M. Conventional and contemporary luting cements: an overview.
J Indian Prosthodont Soc. 2010 Jun;10(2):79-88

Glass ionomer is the generic name of a group of materials that
use silicate glass powder and an aqueous solution of polyacrylic
acid.
The cement produces a Chemical bonding to tooth structure.

Powder
Silica (Sio2) 35.2--41.9% translucancy
Alumina (Al2o3) 20.1--28.6% skeletal structure
Aluminium Flouride –
(Alf3)
1.6 – 2.4 %
Calcium Fluoride (Caf2) 15-20 % glass will fuse
Sodium Fluoride (Naf) 3.6--9.3 %
Aluminium Phosphate (Alpo4
)
3.8 – 12 % Decrease melting
temperature
Lanthanum, Strontium, Bariu
m In Traces
IN TRACE

Film thickness 25μm or less.
Working time about 3 to 5 minutes.
The setting time is 5 to 9 minutes.
Polyacrylic acid 45 %
Water 50 %
Itaconic acid 05 %
Modifiers maleic acid tricarballylic acid

Glass ionomer bonds chemically to the tooth structure.
The bonding is due to the reaction between the carboxyl groups of the
polyacid with the calcium in the apatite of the enamel and dentin.
The bond strength of enamel is always higher than that of dentin
because of the greater inorganic content of enamel and its greater
homogenicity from a morphological stand point.
Diaz-Arnold AM, Vargas MA, Haselton DR. Current status of luting agents for fixed
prosthodontics. J Prosthet Dent. 1999 Feb;81(2):135-41.
MECHANISM OF RETENTION

 Cement exposed to ambient air
 Surface will craze and crack as a result of desiccation,
 Leading to cohesive failure from microcrack formation
 Smith D.C. states the cause of post cemented sensitivity as bacterial
invasion, hydraulic pressure, acidity in the early setting stage and wash
out of thin mix.
Hornsby PR (1980) Dimensional stability of glass-ionomercements. J Chem Tech Biotechnol 30:595–601

 Cast crown
 PFM crown
 Cast post and core.
Dent. 1999 Feb;81(2):135-41.
 Pressed ceramic crown
 Ceramic inlay
 Ceramic veneer
 Resin bonded FPD
 Crown or FPD with poor
retention.
INDICATIONS
CONTRAINDICATIONS

 Self cured and light cured ionomers (or resin modified glass
ionomers)
are available for cementation.
Composition
 Radiopaque, fluroaluminosilicate glass and a micro encapsulated
potassium persulfate and ascorbic acid catalyst system.
 The liquid is an aqueous solution of polycarboxylic acid modified
with pendant methacrylate groups. It also contains 2 –
hydroxyethylmethacrylate (HEMA) and tartaric acid.

Setting reaction
Dual mechanism Setting of hybrid ionomer cements usually
results from an acid base glass ionomer reaction and self-cured
or light cured polymerization of the pendant methacrylate
groups.
The working time is 2.5 minutes.

Dent. 1999 Feb;81(2):135-41.
MECHANISM OF RETENTION
The bonding mechanism to tooth structure is similar to that of
conventional GIC. Micromechanical retention also plays a
important role in bonding process.

Diaz-Arnold AM, Vargas MA, Haselton DR. Current status of luting agents for fixed prosthodontics. J
Prosthet Dent. 1999 Feb;81(2):135-41.
Indications
 Cast crown
 PFM crown
 Cast post and core.
Contraindications
 Pressed ceramic crown
 ceramic inlay,
 ceramic veneer
 Resin bonded FPD Crown.

COMPOMER
• ‘Compomer’ is derived from composite and glass ionomer,
• Fluoride releasing capability of conventional GIC
COMPOSITION
• Powder: strontium aluminofluorosilicate, metallic oxides,chemical-
activated and/or light-activated initiators.
• Liquid: polymerizable methacrylate/carboxylic acid ,monomers,
multifunctional acrylate monomers, water.

• Tensile strength, flexural strength and wear resistance of
compomer is superior.
• Glass-ionomer cement but less effective than resin composites
• Cementation of metal prosthesis
• Hygroscopic expansion - all-ceramic crowns
Ladha K, Verma M. Conventional and contemporary luting cements: an overview. J Indian Prosthodont Soc. 2010 Jun;10(2):79-88
PROPERTIES

• Polymerisation reaction.
• Combinations of an aromatic dimethacrylate with other
monomers containing various amounts of ceramic filler.
APPLICATION
• Bonding ceramic crowns, FPD,
inlays and veneers.
Robert G.Craig -Restorative dental materials- 11th edition

Mechanism of matrix formation
(1) Self- or auto-curing
(2) Light activated-curing
(3) Dual-curing.
Four division (based on bonding procedure)
Total etch, bond, plus resin
One-step etch-bond, plus resin
Self-adhesive resin;
Dual-affinity adhesive resin.
Hill EE, Lott J. A clinically focused discussion of luting materials. Aust Dent J. 2011 Jun;56 Suppl 1:67-76

PROPERTIES
BIOLOGIC EFFECTS
• Polymerization shrinkage
• Microleakage
Film Thickness 20 - 60 µm
Setting Time 3 – 7 mins
Compressive Strength 70 - 200 Mpa
Tensile Strength 25 – 40 Mpa
Modulus of elasticity 4 – 6 Gpa
Solubility 0.05 wt%

 Dual-polymerizing resin based cements possess poorer color stability
than light-polymerizing resin-based cements and therefore are usually not
indicated for the cementation of thin and more translucent ceramic
veneers.
 Due to oxidization of the unreacted amine coinitiator from the redox
polymerization system. The coinitiators in light-polymerizing materials
are more chemically stable and tend to cause less colour variation over
time
Hekimoglu C, Anil N, Etikan I. Effect of accelerated aging on the color stability of cemented
laminate veneers. Int J Prosthodont 2000;13:29-33
LIGHT CURE ADHESIVE

Zinc phosphate cement and glass ionomer cement and adhesive
resins.
Zinc phosphate cement and glass ionomer cement may have
solubility problems in oral environments compared with resin
cements
Dual cure adhesive resin shows greater retentive strength than
zinc phosphate cement in cementing implant.
Pan YH, Lin TM, Liu PR, Ramp LC. Effect of Luting Agents on Retention of Dental Implant-Supported Prostheses. J Oral Implantol. 2015 Oct;41
DUAL CURE ADHESIVE

High strength Higher film thickness
Low solubility Microleakage
High micromechanical bonding Pulpal sensitivity
Difficulty in removing excess cement

• Formulated by adding the following to MMA
(1950)monomer:
• 4 methacryloxy ethyl trimellitate anhydride
(4-META)
• 10-methacryloyloxydecyl dihydrogen
phosphate (MDP)
APPLICATION
• Luting FPD and base metal , Zirconia
• Bonding amalgam to dentin

PROPERTIES
• (similar to a resin cements)
• Stronger and less soluble
• Low rigidity and visco-elastic properties
• No effective bond to the tooth structure in the presence of moisture
• Moderate strength and high deformation under a load.

 Zirconia need not only be roughened but also chemically activated .
 In vitro studies have shown that treating zirconium oxide restorations
with a combination of tribochemical silica sand blasting and 3 MPTS
coupling agent 10 MDP Silane primers produce highest bond strength .
de Souza GM, Silva NR, Paulillo LA, De Goes MF, Rekow ED, Thompson VP. Bond strength of high-crystalline
content zirconia after different surface treatments. J Biomed Mater Res B Appl Biomater 2010;93(2):318-323
Inokoshi M, Van Meerbeek B. Adhesively luted zirconia restorations: why and how? J Adhes Dent. 2014 Jun;16(3):294

 Marginal seating of the Ni-Cr alloy cast restoration when luted with
adhesive resin cement was greater than both the other cements
Pattanaik BK, Nagda SJ. An evaluation of retention and marginal seating of Ni-Cr alloy cast restorations using three different luting
cements: an in vitro study. Indian J Dent Res. 2012 Jan-Feb;23(1):20-5

To achieve a clinical success, the clinician should be aware of
the qualities, advantages and disadvantages of each type of
cement and its ability to lute the various indirect restorations.

 Kenneth J.Anusavice -Philip’s science of dental materials- 11th edition.
 Robert G.Craig -Restorative dental materials- 11th edition.
 William J.O’Brien -Dental materials and their selection- 3rd edition.
 Stephen f. Rosenstiel, Contemporary Fixed Prosthodontics- 3rd edition.
 Herbet T. Shillingburg - Fundamentals of fixed prosthodontics third
edition.
 Notes on dental materials E.C COMBE 6TH edition

 Pan YH, Lin TM, Liu PR, Ramp LC. Effect of Luting Agents on Retention of
Dental Implant-Supported Prostheses. J Oral Implantol. 2015 Oct;41
 Pattanaik BK, Nagda SJ. An evaluation of retention and marginal seating of
Ni-Cr alloy cast restorations using three differen luting cements: an in vitro
study. Indian J Dent Res. 2012 Jan Feb;23(1):20-5
 Hekimoglu C, Anil N, Etikan I. Effect of accelerated aging on the color
stability of cemented laminate veneers. Int J Prosthodont 2000;13:29-33
 Inokoshi M, Van Meerbeek B. Adhesively luted zirconia restorations: why and
how? J Adhes Dent. 2014 Jun;16(3):294
 de Souza GM, Silva NR, Paulillo LA, De Goes MF, Rekow ED, Thompson
VP. Bond strength of high-crystalline content zirconia after different surface
treatments. J Biomed Mater Res B Appl Biomater 2010;93(2):318-323

 Diaz-Arnold AM, Vargas MA, Haselton DR. Current status of luting agents for
fixed prosthodontics. J Prosthet Dent. 1999 Feb;81(2):135-41.
 Jivraj SA, Kim TH, Donovan TE. Selection of luting agents, part 1. J
Calif Dent Assoc. 2006 Feb;34(2):149-60 .
 Richard van N (2002) Introduction to dental materials. Mosby,London, pp
257–278
 Oilo G, Jorgensen KD (1978) The influence of surface roughnessin the
retentive ability of two dental luting cements. J OralRehabil 5:377–389
 Timothy WF (1916) The Dental Review. Our present cements with special
reference to those containing copper, vol XXX, No. 8, Chicago, pp 691–704
 Hembree JH, George TA, Hembree ME (1978) Film thickness of cements
beneath complete crowns. J Prosthet Dent 39:533–535

Luting agents used in prosthodontics

Luting agents used in prosthodontics

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