Dental cements have a wide range of dental and orthodontic applications. Common uses include temporary restoration of teeth, cavity linings to provide pulpal protection, sedation or insulation, and cementing fixed prosthodontic appliances. Recent uses of dental cement also include two-photon calcium imaging of neuronal activity in the brains of animal models in basic experimental neuroscience.
Traditionally, cements have separate powder and liquid components which are manually mixed. Thus, working time, amount and consistency can be individually adapted to the task at hand. Some cements, such as glass ionomer cement (GIC), can be found in capsules and are mechanically mixed using rotating or oscillating mixing machines. Resin cements are not cements in a narrow sense, but rather polymer-based composite materials. ISO 4049: 2019 classifies these polymer-based luting materials according to curing mode as class 1 (self-cured), class 2 (light-cured), or class 3 (dual-cured). Most commercially available products are class 3 materials, combining chemical- and light-activation mechanisms.
Dental cements can be utilised in a variety of ways depending on the composition and mixture of the material. The following categories outline the main uses of cements in dental procedures.
Unlike composite and amalgam restorations, cements are usually used as a temporary restorative material. This is generally due to their reduced mechanical properties, which may not withstand long-term occlusal load.
Amalgam does not bond to tooth tissue and therefore requires mechanical retention in the form of undercuts, slots and grooves. However, if insufficient tooth tissue remains after cavity preparation to provide such retentive features, a cement can be utilised to help retain the amalgam in the cavity.
Historically, zinc phosphate and polycarboxylate cements were used for this technique; however, since the mid-1980s, composite resins have been the material of choice due to their adhesive properties. Common resin cements utilised for bonded amalgams are RMGIC and dual-cure resin-based composite.
When a cavity reaches close proximity to the pulp chamber, it is advisable to protect the pulp from further insult by placing a base or liner as a means of insulation from the definitive restoration. Cements indicated for liners and bases include:
Pulp capping is a method to protect the pulp chamber if the clinician suspects it may have been exposed by caries or cavity preparation. Indirect pulp caps are indicated for suspected micro-exposures, whereas direct pulp caps are placed on a visibly exposed pulp. To encourage pulpal recovery, it is essential to use a sedative, non-cytotoxic material such as setting calcium hydroxide cement.
Luting materials are used to cement fixed prosthodontics such as crowns and bridges. Luting cements are often of similar composition to restorative cements; however, they typically have less filler, resulting in a less viscous cement.
Cements are classified based on their components. Generally, they can be classified into categories:
Cements can be classified based on the type of their matrix:
Based on time of use:
These cements are resin-based composites. They are commonly used to definitively cement indirect restorations, especially resin-bonded bridges and ceramic or indirect composite restorations, to the tooth tissue. They are usually used in conjunction with a bonding agent, as they cannot bond directly to the tooth; however, some products can be applied directly to the tooth (self-etching products).
There are three main resin-based cements:
Resin cements are available in a range of shades to enhance aesthetics.
Zinc polycarboxylate was invented in 1968 and was revolutionary as it was the first cement to exhibit the ability to bond to the tooth surface chemically. Very little pulpal irritation is seen with its use due to the large size of the polyacrylic acid molecule. This cement is commonly used for the installation of crowns, bridges, inlays, onlays, and orthodontic appliances.
Composition:
Adhesion:
Indications for use:
Zinc phosphate was the first dental cement to appear on the dental marketplace and is considered the âÂÂstandardâ for other dental cements to be compared to. The many uses of this cement include permanent cementation of crowns, orthodontic appliances, intraoral splints, inlays, post systems, and fixed partial dentures. Zinc phosphate exhibits a very high compressive strength, an average tensile strength and an appropriate film thickness when applied according to the manufacturer's guidelines. However, issues with the clinical use of zinc phosphate are its initially low pH when applied in an oral environment (linked to pulpal irritation) and the cement's inability to chemically bond to the tooth surface, although this has not affected the successful long-term use of the material.
Composition:
Formerly known as the most commonly used luting agent, zinc phosphate cement works successfully for permanent cementation. It does not possess anticariogenic effects, is not adherent to tooth structure, and acquires a moderate degree of intraoral solubility. However, zinc phosphate cement can irritate the nerve pulp; hence, pulp protection is required. The use of polycarboxylate cement (zinc polycarboxylate or glass ionomer) is highly recommended, as it is a more biologically compatible cement.
Dental materials such as fillings and orthodontic instruments must satisfy biocompatibility requirements as they will be in the oral cavity for a prolonged period. Some dental cements can contain chemicals that may induce allergic reactions in various tissues in the oral cavity. Common allergic reactions include stomatitis/dermatitis, urticaria, swelling, rash and rhinorrhea. These may predispose to life-threatening conditions such as anaphylaxis, oedema and cardiac arrhythmias.
Eugenol is widely used in dentistry for different applications, including impression pastes, periodontal dressings, cements, filling materials, endodontic sealers, and dry socket dressings. Zinc oxide eugenol is a cement commonly used for provisional restorations and root canal obturation. Although classified as non-cariogenic by the US Food and Drug Administration, eugenol is proven to be cytotoxic, with the risk of anaphylactic reactions in certain patients.
Zinc oxide eugenol is a mixture of zinc oxide and eugenol that forms a polymerised eugenol cement. The setting reaction produces an end product called zinc eugenolate, which readily hydrolyses, producing free eugenol that causes adverse effects on fibroblast and osteoclast-like cells. At high concentrations, localised necrosis and reduced healing occur, whereas for low concentrations, contact dermatitis is the common clinical manifestation.
Allergy contact dermatitis has been proven to be the highest clinical occurrence, usually localised to soft tissues, with buccal mucosa being the most prevalent. Normally, a patch test done by dermatologists will be used to diagnose the condition. Glass ionomer cements have been used to substitute zinc oxide eugenol cements (thus removing the allergen), with positive outcomes from patients.