The world of dentistry has come a long way in the past 50 years. Gone are the days when dentists had a simple choice between
gold crowns and zinc phosphate cement. Today's dental professionals face a complex array of restorative materials and luting
cements, each with its own strengths and ideal applications.
Permanent cements can be broadly categorized into two types: luting cements and bonding (adhesive) cements. Luting cements,
primarily used for metal-based restorations, are self-cured. Bonding cements, on the other hand, can be self-cured, dual-cured, or
light-cured.
Traditional Luting Cements
The oldest technologies in dental cements include zinc phosphate, polycarboxylate, and conventional glass ionomers. These cements
boast a long, well-understood clinical history and are cost-effective. They are best suited for metal or metal-supported restorations
with mechanically retentive preparations. However, due to their low strength and adhesion, they are not recommended for most
ceramic-based and all composite-based restorations.
Resin-Modified Glass Ionomers
Introduced in 1994, resin-modified glass ionomers have become the dominant luting cement type. These cements combine traditional
glass ionomer technology with methacrylate monomers and cure initiators. The result is a cement with improved properties, including
easy cleanup, better adhesion to tooth structure, higher strength, low solubility, and reduced postoperative sensitivity. Recent
improvements have focused on ease of use and reliability, leading to the introduction of paste/paste technologies.
Composite Resin Cements
Composite resin cements are essentially modified composite restorative materials. They offer high strength, high adhesion, low
solubility, and excellent esthetics. These properties make them ideal for use with weaker, esthetic restorations such as glass ceramics
and indirect composites, or in cases where retention is a concern.
There are a few subtypes of composite resin cements:
The total-etch and self-etching primer systems can be technique-sensitive and require careful moisture control. The self-adhesive
cements, being the newest type, offer a broad range of indications, simplified procedures, and moisture-tolerant chemistry, making
them the first true universal indication cements.
Choosing the Right Cement
The choice of cement depends primarily on the restoration material and the clinical situation. Weak restorations, such as
all-porcelain or all-composite crowns, inlays, onlays, and veneers, must be adhesively bonded with strong cements to prevent
fractures. For porcelain or glass ceramics, using silane coupling agents can enhance bond strength.
Metal or metal-based restorations, being inherently strong, can be used with any cement type. A recent poll showed that most
porcelain-fused-to-metal crowns are cemented with traditional luting cements, with over half of clinicians choosing resin-modified
glass ionomers.
Conclusion
While the choices may seem overwhelming, selecting the appropriate cement becomes straightforward when following a simple
rule: strong restorations with good retention can be luted with any cement, while weak restorations or those with little retention must
be bonded with strong cements, typically composite resins.
The latest self-adhesive cements, such as ProLink Cem Plus. Which offer a combination of high bond strength and excellent and
easy application cover a broad range of restoration challenges, simplifying cement selection while meeting both functional and
aesthetic demands.
As dental technology continues to evolve, staying informed about the latest cement options and their ideal applications will help
dentists provide the best possible care for their patients.