Literature Review

Journal of Veterinary Dentistry

2018, Vol. 35(1) 18-27
A Review of Dental Cements ª The Author(s) 2018
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DOI: 10.1177/0898756418755339
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Kipp Wingo, DVM, DAVDC1

Abstract
This review provides an in-depth comparison of advantages and disadvantages of different types of dental cements as they are used
for cementing base metal alloy crowns in dogs.

Keywords
veterinary dentistry, cements, crown, luting cement, prosthodontics

Introduction or plaque inhibition, (3) microleakage, (4) strength and other

mechanical properties, (5) solubility, (6) water adsorption, (7)
Dental cements provide a link or adhesive between a restora-
adhesion, (8) setting stresses, (9) wear resistance, (10) color
tion and prepared tooth, bonding them together through some
stability, (11) radiopacity, (12) film thickness or viscosity, and
form of surface attachment. The cementing agent’s primary
(13) working and setting times.
requirement is to hold a restoration in place for an indefinite
period of time and maintain a seal between the restoration and
the tooth.1 A term sometimes used to refer to final placement of Biocompatibility
a fixed prosthodontic restoration is to “lute” the restoration. It An ideal dental cement should be biocompatible (ie, have little
derives from the Latin lutum, which means mud or clay. A interaction with body tissues and fluids), nontoxic, and have
“luting agent” is the substance—such as cement, wax, or low allergic potential.3
clay—that coats a joint area to make a tight seal. Historically,
luting agents were used to mechanically link restorations to a
prepared tooth. Today, most dental cements have significant Caries or Plaque Inhibition
adhesive properties, and thus, the terms “crown-cement” or Caries are one of the primary causes of failure of cast restora-
“crown cementation” are more appropriate.2 tions in humans, which led to the popularity of the glass iono-
Dental cements are brittle materials when hardened, often mer cements. This was due to the fluoride release associated
formed by mixing powder and liquid together. They are either with these materials4 and the presumed benefit of reduced car-
resin-based cements or acid–base cements. In the latter, the ies. An ideal dental cement possesses antimicrobial properties
powder is a basic metal oxide or silicate and the liquid is acidic. that reduce the effect of future plaque colonies at the restora-
An acid–base reaction occurs with the formation of a metal salt, tion margins. Caries have not been reported as a significant
which acts as the cementing matrix. Dental cements are used cause of restoration failure in veterinary dentistry.
for a variety of dental and orthodontic applications, including
use as crown cementing agents, pulp protecting agents, or cav-
ity lining material. This article addresses dental cements and Microleakage
their use in veterinary dentistry. A restoration cemented with the ideal dental cement would be
The ideal cement has not yet been discovered; however, it resistant to microleakage. In humans, microleakage of organ-
should meet the following criteria: (1) not harmful to the tooth isms around dental restorations has been implicated in adverse
or surrounding tissues, (2) allows sufficient working time to pulpal response and reduced restoration longevity.5 Restoration
place the restoration, (3) be fluid enough to allow complete leakage is the most common cause of endodontic failure in
seating of the restoration, (4) quickly forms a hard structural humans and can be a cause of failure in full crown metal
layer strong enough to resist functional forces, and (5) does not
dissolve and maintains a sealed, intact restoration (Table 1).3
1
Arizona Veterinary Dental Specialists, Scottsdale, AZ, USA

Properties of Dental Cements Corresponding Author:

Kipp Wingo, Arizona Veterinary Dental Specialists, 1109 E. Falling Star Road,
Scientific studies of dental cements used in humans have eval- Phoenix, Scottsdale, AZ 85086, USA.
uated the following categories: (1) biocompatibility, (2) caries Email: kippwingo1@icloud.com
Wingo 19

Table 1. The Ideal Properties of a Dental Cement.35 of a material is determined by making a symmetrical-shaped
indentation with an indenter that has a standardized force or
Property Ideal Material
weight. The hardness can be calculated from the dimensions of
Film thickness Low the indentation produced. Examples of hardness values for
Working time Long enamel, dentin, cementum, and cobalt–chromium partial den-
Setting time Short ture alloy are 343, 68, 40, and 391 kg/mm2, respectively.29
Compressive strength High An increased incidence of failures can be a consequence of a
Elastic modulus Equal to dentin
material that exhibits high creep. Creep is a time-dependent
Pulp irritation Low
Solubility Very low and gradual deformational change that can occur under cyclical
Microleakage Very low loads such as chewing.
Removal of excess Easy Changes in temperature may adversely affect some dental
Retention High cements. This is clinically significant because testing dental
cements at room temperature may provide different results
compared to testing at body temperature.
restorations.6-8 In man, endodontically treated teeth without
crowns were lost at a 6 times greater rate than endodontically
treated teeth with crowns.9 Solubility
An ideal dental cement is resistant to disintegration and dis-
solution when the cement is submerged in water or other solu-
Strength and Mechanical Properties tions over the lifetime of the restoration. Increased solubility
An ideal dental cement has sufficient mechanical properties to will affect marginal integrity of a restoration leading to
resist functional forces over the lifetime of the restoration. In increased plaque accumulation. Zinc phosphate and polycar-
addition, it resists degradation in the oral environment and boxylate are examples of dental cements with a high solubility.
adheres to the underlying dentin. In order for a restoration to Resin-based cements have a very low solubility.30
function successfully over many years, the dental cement
must be strong enough to resist fracture and cyclical fatigue
stresses.10,11 Compressive strength has also been used as a Water Adsorption
predictor of clinical performance.12-16 Investigators have also Water adsorption refers to adhesion of water molecules to a
studied mechanical properties including flexural strength, surface, whereas absorption refers to uptake of water by the
tensile strength, modulus of elasticity, fracture toughness, entire volume of a structure. Adsorption can adversely affect
hardness testing, creep, and effects of temperature.13,14,17-24 the physical and mechanical properties of the dental cement31,32;
To determine flexural strength, a 3-point bending or flexural however, the resultant expansion may be beneficial, as it coun-
test is performed. The flexural test defines the strength and teracts polymerization shrinkage.33
amount of distortion expected.25 Flexural strength is deter-
mined by forming the material into a simple beam. The beam
is supported, not fixed, at each end and a load is then applied to
Adhesion
the middle. The flexural strength is calculated by the maximum The term adhesion refers to the establishment of molecular
stress applied to material. interactions between a substrate and an adhesive brought into
Diametral tensile strength is an indirect measure of tensile close contact, creating an adhesive joint.34 When using tradi-
strength. It is determined by forming the material to be tested into tional luting agents or nonadhesive dental cements, such as zinc
a disk, then subjecting the disk to diametrical compressive forces phosphate, retention is dependent on the geometric form of the
until fracture occurs. The tensile strength can then be calculated tooth preparation. That limits the paths of displacement of the
mathematically. This test is referred to as the Brazilian method cast restoration35; therefore, some human prosthodontist may
and is favored because is it relatively simple and reproducible.26 use nonadhesive dental cements such as zinc phosphate. In
An elastic modulus, or modulus of elasticity, is a number veterinary dentistry, compared to human dentistry, a suitable
that measures an object or substance’s resistance to being geometric form can rarely, if ever, be obtained. Therefore, most
deformed elastically (ie, nonpermanently) when a force is veterinary dentists use adhesive cements for fixed restorations.
applied to it. In its simplest definition, it is the “stiffness” of In human prosthodontics, mechanical interlocking with
a substance. The ideal elastic modulus of a dental cement is rough surfaces on a parallel tooth wall preparation is frequently
thought to be equal to that of dentin.1 A dental cement with a the primary means of retention for dental cements regardless of
close elastic modulus to that of dentin provides for less stress chemical composition.36 Mechanisms of cementation have
concentration at the cement–tooth interface which results in a been described as nonadhesive, micromechanical, and molecu-
more durable bond. Resin composites with hybrid filler have an lar adhesion.37 Dental cements that are considered nonadhesive
elastic modulus very near that of dentin.27 bonding agents (eg, zinc phosphate) fill the restoration/tooth
Fracture toughness is a property that describes the ability of gap, thereby holding by engaging in small surface irregulari-
a material containing a crack to resist fracture.28 The hardness ties. All cements do this to varying degrees; thus, success of
20 Journal of Veterinary Dentistry 35(1)

nonadhesive dental cements is primarily dependent upon the dental cements when compared to zinc phosphate, glass
geometric form of the tooth preparation.35 In contrast, with ionomer, or polycarboxylate cements.45 This is most likely due
micromechanical bonding, the surface irregularities are to the high viscosity of the resin. Manipulating variables, such as
enhanced through air abrasion (sand blasting) of the restora- the ratios of components and mixing temperature, can influence
tion. Pumice polishing and/or acid etching of the tooth can film thickness. Cold mixing can significantly reduce the film
provide larger defects for the cement to fill with a high tensile thickness of glass ionomers and increase achievable powder–
strength material. Resins and resin-modified glass ionomers liquid ratios.46 Alternatively, dual-cure resin cements exhibit
(RMGIs) are examples of dental cements that micromechani- larger film thicknesses when they are mixed at lower tempera-
cally bond. Molecular adhesion consists of van der Waals tures.47 Generally, glass ionomer has the lowest film thickness
forces and weak chemical bond formation between the dental followed by polycarboxylate, RMGI, zinc phosphate, and resin-
cement and the tooth structure. Two examples of dental based cements.48 All these cements fall within the American
cements exhibiting molecular adhesion are polycarboxylate Dental Association’s specifications for cements and are within
and glass ionomer.1 the range of clinical acceptability for a marginal gap.49,50

Setting Stresses Working and Setting Times

Some dental cements shrink during setting, which causes unde- Generally, a long working time and a short setting time are
sirable stresses in the set material, and can cause contraction desired. Enough time is needed to properly seat the restoration
gaps in the dentin–cement interface. To some extent, these without the dental material setting prior to placing it onto the
stresses can be compensated for by expansion due to water tooth. Conversely, after the restoration is seated, it is desirable
sorption in some dental cements.38 for the dental cement to set as fast as possible. Working times
can be affected by several factors such as temperature, altera-
Wear Resistance tions in powder–liquid ratios, and over- or undermixing. The
working times of glass ionomer and resin cements are
Dental cement wear is seldom a problem with full-coverage metal
decreased as temperature increases.51 Utilization of a frozen
prosthetics in veterinary medicine. Wear is a concern in human
slab technique (18 C to 24 C) will extend the working time
dentistry with the use of inlays, particularly with increased
of zinc phosphate cement. However, the slab temperature most
restoration–tooth gap widths.39 Dental cements used to fix crowns
often used is þ4 C and þ8 C (refrigerator temperature) due to
have been tested in vitro for wear, and wear performance is not
the achievement of maximum compressive strength.52 The use
well correlated with mechanical properties data.40
of a chilled slab will significantly extend the working time of
glass ionomer cements.53 Too much powder will reduce the
Radiopacity working time of glass ionomers. The working times of resin-
In human prosthodontics, an ideal dental cement should be based cements are not significantly reduced by variations in the
radiopaque to enable the practitioner to distinguish between a mass ratio of base and catalysts, up to 20%.54 With dual-cure
cement line and recurrent caries; therefore, it is important that composite resin cements, working times are significantly
dental cements have greater radiopacity than dentin. One study reduced by the use of a dual-cure adhesive.55 The typical
of 435 dogs reported a 5.3% incidence of caries41; however, mixing time of glass ionomers is 10 seconds at 3000 cycles per
there have been no studies performed to determine the preva- minute using a triturator; either too long or too short of a
lence of caries associated with full veneer crowns in dogs. The mixing cycle can adversely affect working time.56
use of full crown restorations made from metal renders the
radiopacity of the dental cement moot. This is also true for Ease of Use
color stability of the dental cement.
The ability to completely remove excess dental cement after
cementation can be a concern. In human dentistry, rapid-onset
Film Thickness complications associated with excess cement left around
The film thickness or viscosity of the dental cement can crowns have been documented.57 The removal of bulk cement
directly affect long-term clinical success. Generally, dental can be very difficult to accomplish without damaging the sur-
cements should exhibit low film thickness. Low film thickness rounding tissues, which would expose the early cement margin
improves the seating of the crown and decreases marginal dis- to blood and saliva. Excess tissue-damaging cement can reduce
crepancies, thereby reducing plaque accumulation, periodontal the bond strength and accelerate erosion.58,59 Removal of the
disease, cement dissolution, and caries (humans).42 Resin- overabundance of cement that must occur right after the initial
based adhesives typically have a higher film thickness; set may unfortunately pull unset cement from under the restora-
however, resin cements are less soluble in oral fluids that com- tion margin. Generally, zinc phosphate is the easiest to remove,
pensate.43 As the film thickness increases, the tensile bond and resin-based cements are the most difficult. The ideal dental
strength of cements to cast alloy crowns decreases.44 Increased cement will reach an intermediate stage during setting when it
incidence of tilted crowns has been associated with resin-based is possible to easily “peel away” the excess cement in one or
Wingo 21

Table 2. The Basic Composition of Dental Cements. Zinc Phosphate

ZOE Zinc oxide þ eugenol + EBA Zinc phosphate has the longest track record of use in dentistry.
Zinc phosphate Zinc oxide þ magnesium oxide þ phosphoric It was introduced in the 1800s and is the oldest dental cement.1
acid þ water þ buffers For many decades, it was the “gold standard” for permanent
Polycarboxylate Zinc oxide þ polyacrylic acid
dental cementing agents and showed a success rate of up to
Glass ionomer Polycarboxylate þ fluoroaluminosilicate glass þ
water þ tartaric acid 98%.66 It is the cement other cements have been measured
RMGI Glass ionomer þ resin against. It is still commonly used in human dentistry for per-
Compomer Glass ionomer þ Composite (resin þ glass filler) manent and often temporary dental cements; however, resin-
Resin-based Resin þ filler (glass or silica) based cements are more convenient and have been shown to
cements provide a greater retentive force compared to zinc phos-
Abbreviations: EBA, ethoxybenzoic acid; RMGI, resin-modified glass ionomer.
phate.50,67-69 Zinc phosphate dental cement is prepared by mix-
ing zinc oxide and magnesium oxide powders with a liquid
consisting principally of phosphoric acid, water, and buffers.
two pieces without breaking it into multiple small parts. This is
quicker, easier, and helps to ensure the cement is completely
removed and no loose residue remains subgingivally. Polycarboxylate
In 1968, zinc polyacrylate (polycarboxylate) cements were
introduced, the first dental cement that adheres to tooth
Water-Based Cements structures.70 The goal was to develop a dental cement that
Zinc phosphate, polycarboxylate, glass ionomer, zinc oxide combined the strength of zinc phosphate cements with the
eugenol (ZOE), and ethoxybenzoic acid (EBA)-reinforced adhesiveness and biocompatibility of ZOE cements.71 The
ZOE cements are water-based cements that have traditionally zinc oxide and the polyacrylic acid react to form a zinc poly-
been the mainstays for cementing indirect restorations acrylate that surrounds the partially reacted zinc oxide powder
(Table 2). All water-based cements have increased solubility,4 particles.72
lower strength,60 greater microleakage,61,62 and lower bond In human dentistry, zinc polycarboxylate cements are water-
strength63,64 than the resin-based cements. Zinc oxide none- based cements used as final cements for retention of crowns
ugenol and ZOE are good temporary cements. Polycarboxy- and bridges.72 Polycarboxylate cements are not as strong as
late is more durable and bonds to teeth but has significant zinc phosphate cements but are less irritating to the pulp.41 In
solubility. Zinc phosphate, long the mainstay of cementation, general, the compressive strength for polycarboxylate is
has high solubility but has a higher retention rate than poly- approximately one-half to two-thirds that of zinc phosphate,
carboxylate, yet it does not actually bond to teeth. Glass iono- and the tensile strength is one-third more than that of zinc
mer and polycarboxylate were designed to bond to tooth phosphate.73 The modulus of elasticity (stiffness) has one-
structure and to improve cement properties. Glass ionomer third of the range of zinc phosphate, therefore providing a
cements bond to teeth and are lower in solubility and have a material that can display significant plastic deformation upon
higher retention rate than zinc phosphate. loading.73 The solubility of polycarboxylate is similar to zinc
phosphate. Acidic conditions of the mouth (such as in patients
that have chronic vomiting) can greatly increase the erosion of
Zinc Oxide the cement.74
Zinc oxide eugenol’s popularity is the result of its ease of use,
antibacterial action, and a desensitizing effect on irritated pul-
pal tissue.34 The ZOE cements are considered more biocompa-
Glass Ionomer
tible because of their neutral pH, minimal interaction with Glass ionomer was first introduced in 1969 and was originally
tissues and fluids, and are relatively nontoxic when compared known as aluminosilicate polyacrylic acid.1 Glass ionomer
to RMGIs and resin cements.34 combined the technologies and chemistry of silicate and zinc
The reaction between zinc oxide and eugenol has several polycarboxylate materials to incorporate the desirable charac-
applications in dentistry such as endodontic sealers and root- teristics of both.75 “Glass polyalkenoate cement” is the official
end filling materials, periodontal coating, inelastic impression name used by the International Standards Organization; the
materials, cavity base, and temporary restorations in human term “glass ionomer” is considered generic and covers a larger
dentistry.34 In the mid-1970s, reinforced ZOE cements and group of cements with similar compositions.74 Glass ionomers
cements containing EBA were developed. These cements have contain finely ground glass filler and fluoroaluminosilicate
considerably better mechanical properties and are therefore (FAS), which avoids the susceptibility to dissolution by sub-
used as definitive fixing cements in selected cases in human stituting phosphoric acid with the polymeric carboxylic acids
prosthodontics.65 Due to the lower bond strength and rare use of zinc polycarboxylate materials.75 Original glass ionomer
of temporary restorations, zinc oxide cements are seldom used systems have undergone several changes, but all conventional
in veterinary dentistry for full-coverage prosthodontics crowns. glass ionomers have the following components:75
22 Journal of Veterinary Dentistry 35(1)

 polycarboxylic acid replaced with a water–hydroxymethyl methacrylate mixture

 FAS glass plus an initiator/activator for the added resin. Newer systems
 water, and are more complex and include other dimethacrylates such as
 tartaric acid ethylene glycol dimethacrylate, glycidylmethacrylate, and
Bis-GMA, as well as various chemicals to initiate and control
Tartaric acid is added to increase the working time and the resin polymerization.74 The RMGIs use an electrostatic
improves the setting reaction of the cement.75,76 Tartaric acid interaction of polycarboxylate acid with hydroxyapatite of the
acts as an accelerator that aids in the extraction of ions from tooth to bond to dentin and enamel. The RMGIs form ionic
aluminosilicate glass and facilitates their binding to polyanion bonds with hydroxyapatite around the collagen in the dentin
chains. Postsetting hardening is significantly increased.77 together with the micromechanical interlocking of the RMGI
The original use of glass ionomers was as restorative mate- that hybridizes the dentin.84 The resin component provides a
rials for anterior teeth in humans. They exhibit molecular micromechanical interlock to dentin and enamel. The hybri-
adhesion to dental hard tissues and release fluoride for a rel- dization with dentin creates greater bond strength compared
atively longer period. Molecular adhesion to tooth structure is to conventional glass ionomers and results in higher fracture
achieved by chelation with calcium and phosphate ions in resistance compared to glass ionomers but less than standard
dentin and enamel. Glass ionomers are also used as dental resin-based cements.85-87
cements. Water balance of the newly placed cement is impor- The bond strength of RMGI to various indirect materials has
tant, as the cement contains water and releases water during been tested and has been found to fall between conventional
the setting process. During the first several minutes, the glass ionomer and resin-based cements for sandblasted Ni-Cr
cement can be contaminated by saliva causing loss of cement alloys. 88 The RMGI has approximately double the bond
by erosion due to early solubility.1 It is generally recom- strength to sandblasted, high-noble metal alloys when com-
mended to temporarily protect the glass ionomer cement with pared to conventional glass ionomers and zinc phosphate, but
a varnish after bulk removal because portions of the ions are resin-based cements have 6 to 10 times higher bond strength
still in a soluble form while the matrix is forming.74 It has been than RMGI.63
demonstrated that leaving excess glass ionomer undisturbed The mechanical properties of RMGI fall behind those of the
for 10 minutes prevented any significant erosion in a wet field. self-adhesive resin-based and conventional resin-based
Conversely, keeping the exposed cement dry too long cements.89,90 The RMGI is less susceptible to early erosion
increased the potential for dehydration and microcracking.78 during setting, less soluble, and has higher compressive and
The application of petroleum jelly to the exposed cement mar- tensile strengths than unmodified glass ionomer dental
gin has been suggested as a simple solution to maintain water cements. Film thickness and adhesion to tooth structure are
balance.79 The new glass ionomer cements are fast setting and similar.91 They also release fluoride, which enhances cario-
have a higher resistance to water within 5 minutes; therefore, it static potential, but the amount varies by product.4 Excess
is unnecessary to use a waterproof varnish or resin sealer to RMGI can be difficult to remove due to the presence of resin.
cover the exposed cement.80 Dehydration is still a concern, so
isolation from the oral environment longer than 10 minutes is
not recommended. Laboratory tests have reported that the Compomers
compressive strength and crown retention results of glass The addition of resins to conventional glass ionomers led to the
ionomers are higher than zinc phosphate. Microleakage evolution of a new and diverse group of potential dental-
studies give variable comparisons, and antibacterial proper- cementing materials, which now represent a broad spectrum
ties are considered slightly better than zinc phosphate.4 Glass of products ranging from conventional glass ionomer to com-
ionomer cements have a low flexural strength but a high mod- posite resin. A composite resin is resin mixed with a filler
ulus of elasticity and are therefore very brittle and prone to material. The filler in composites used for the creation of com-
bulk fracture.81 The strength properties of glass ionomer pomers is glass. Compomers, also known as polyacid-modified
cements are much inferior to those of resin cements and composite resins, appeared in the late 1990s 92 and were
therefore should not be used in restorations that are high described as being a combination of composite resin (comp)
stress locations. 81,82 Shelf life may be an issue because and glass ionomer (omer), offering the advantages of both.80
viscosity has been shown to increase after 24 months.83 Compomers are really anhydrous resins that contain ion-
leachable glass as part of the filler and dehydrated polyalkenoic
acid (mostly composite with some glass ionomer).1 The phys-
Resin-Modified Glass Ionomer ical behavior of compomers is more like that of composite
In the 1980s, with the desire to improve resistance to fracture resins than of glass ionomers, with higher compressive and
and dissolution, water-soluble polymers (or polymerizable flexural strengths than RMGI but inferior strength to unmodi-
resins) were added to conventional glass ionomers to create a fied composite cements.92 Little, if any, tooth adhesion occurs
new category of dental cements called RMGIs.58,80 They are without a resin-bonding agent, and fluoride release is very
also known as “hybrid ionomers.” In the original RMGI, part of limited.80 Cleanup of excessive compomer can be challenging
the water component of glass polyalkenoate cement was due to the presence of the resin.
Wingo 23

Table 3. Comparison of Available Dental Cements.25,35

Ideal Zinc Glass Self-Adhesive
Property Material Phosphate Polycarboxylate Ionomer RMGI Compomer Resin Based Resin Based

Film thickness, Low (<40) 25.3 19 13.5 23.1 >25 29.6 <25
mm
Working time, Long 1.5-5 1.75-2.5 2.3-3.5 2-4 3-10 0.5-5 0.0-5
minutes
Setting time, Short 5-14 6-9 6-9 2 3-7 1-15 1-15
minutes
Compressive High 62-101 67-91 122-162 40-141 194-200 179-225 200-240
strength, MPa
Tensile strength, High 3.1-4.5 3.6-6.3 4.2-5.5 13-24 36-40 34-37 37-41
MPa
Elastic modulus, Equal to 13.2 5-6 11.2 2.5-7.8 17 4.5-9.8 3-15
GPa dentin
(13.7)
Pulp irritation Low Moderate Low High High High High High
Solubility Very low High High Low Very low Very low Very low Very low
Microleakage Very low High High to very Low to Very low High to very high Very low Very low
high very
high
Removal of Easy Easy Medium Medium Medium Medium Difficult Difficult
excess
Retention High Moderate Low/moderate Moderate Moderate Moderate High High
to high
Mode of bond to N/A Nonadhesive Molecular Molecular Molecular Molecular Micromechanical Micromechanical
tooth bonding adhesion adhesion adhesion and adhesion and
micromechanical micromechanical
Fluoride release N/A No No Yes Yes Yes No No

Abbreviations: RMGI, resin-modified glass ionomer; N/A, not applicable.

Resin-Based Cements than most other materials used for cementation,91,97-104 costing
up to 175 times that of zinc phosphate.83 Removal of excess
Methyl methacrylate-based resin cements have been available
resin-based cement can be difficult.
since 1952 for cementation of indirect restorations.93 There
have been many reformulations and improvements over the
years. Resin-based cements are composed of the same basic
components as composite restorative material; however, they
have lower concentrations of filler particles (50%-70% by
Self-Adhesive Resin-Based Cements
weight of glass or silica).91 Additionally, the distribution of the Resin-based cements have long been valued because of their
filler and initiator content has been altered to allow for a lower high retentive strength, resistance to wear, and low solubi-
film thickness and suitable working and setting times.94 lity.105 However, one of the common dissuading factors regard-
The major constituents of resin-based cements are dimetha- ing their use is the need of multiple steps (etching, drying,
crylate resin and glass filler and often proprietary enhance- priming) for bonding. Self-adhesive resin-based cements are
ments. 95 Resins bond to enamel by micromechanical defined as cements based on filled polymers designed to adhere
interlocking into an acid-etched surface. Bonding to dentin is to tooth structure without the necessity of separate etching,
also micromechanical but is more complex, often requiring drying, and priming. The first commercial product was RelyX
multiple steps that include removal of the smear layer and Unicem,a which was introduced to dentistry in 2002. Self-
surface demineralization. This is followed by application of adhesive resins have gained rapid popularity with more than
an unfilled resin-bonding agent or primer to which the resin a dozen commercial brands now available.106 Self-adhesive
chemically bonds.1 Resin-based cements reduce microleakage resin-based cements were developed to provide a dental cement
and have remarkably low solubility, improved strength, and with a simple application procedure, combining the advantages
improved retention compared to water-based cements.96 The of glass ionomers (adhesion, fluoride release) with mechanical
compressive and tensile strengths, toughness, and resilience of properties comparable to those of resin-based cements.107 To
resin cements equal or exceed those of other dental cements.1 eliminate the need for etching, priming, and bonding, this mate-
Conversely, most resin-based cements offer no fluoride rial was formulated with phosphoric acid–modified methacry-
release or uptake, and film thickness may be relatively high.1 late monomers, which enable the cement to self-adhere to the
Resin-based cements can be self-cured, light cured, and dual tooth surface. At the same time, the monomers create a cross-
cured. They are the strongest, least soluble, best bonding linked cement matrix during radical polymerization, which
cements. They also are more technique sensitive and expensive contributes to greater mechanical and dimensional stability.108
24 Journal of Veterinary Dentistry 35(1)

Table 4. Ranking of Cement Types Based on Durability, Strength, and improved strength properties, lower solubility, and greater
Cost.14 bond strength than the RMGI. Resin-based cements are the
Durability and Strength Cost
strongest, least soluble, best bonding cements of any of the other
choices. They are also more technique sensitive and more
Lowest Lowest expensive.91,99,100,102-104,115,116 All cements with dual-cure
Zinc oxide noneugenol capability, both conventional resin and self-adhesive resin, show
Zinc oxide eugenol significantly superior properties when light cured.116,119-122
Polycarboxylate
Quality veterinary dentistry, in part, includes the use of
Zinc phosphate
Glass ionomer prosthodontics, which will require the use of dental cements.
RMGI The author’s practice has observed an 80% increase in the
Self-adhesive resin based frequency of prosthodontic applications over a 10-year
Resin based period. It is therefore important for the veterinary dental prac-
Highest Highest titioner to understand the basics of dental cements. Consider-
Abbreviation: RMGI, resin-modified glass ionomer.
ing all variables associated with successful cementation,
resin-based cements consistently yield the best results. While
resin-based cements may significantly improve tensile
These cements undergo a unique change from acidic to strength when related to retention form, occlusal interference,
neutral from initial mixing to 24 hours after application, which and patient stresses, this beneficial property should never
enables them to adhere to tooth structure and also maintain serve as a substitute for meticulous technique in their appli-
long-term strength. Many brands of self-adhesive resin-based cation or in tooth preparation. There is no doubt that new and
cements have a pH of approximately 2.0 immediately after improved dental cements will become available for use in
mixing, which is important in its self-adhesion and also enables veterinary patients. It has been said that the wise dentist is
a high moisture tolerance. This low pH level and accompany- never the first to use a new material or the last to use an old
ing hydrophilicity allow the material to adapt well to the tooth material (Tables 3 and 4).123
structure. However, the cement quickly increases in pH value
and after 24 hours achieves a neutral level of 7.0. At this pH,
the cement is characterized as hydrophobic. This property Materials
makes it resistant to water uptake, helping prevent staining and a. 3M ESPE, St Paul, Minnesota.
cracking and adding to its long-term stability.108
Self-adhesive resin-based cements that self-etch do not Declaration of Conflicting Interests
remove the smear layer, whereas the 3-step and 2-step bonding The author(s) declared no potential conflicts of interest with respect to
systems provide smear layer removal.109 Use of a separate etch- the research, authorship, and/or publication of this article.
ing and bonding step significantly improves the bonding strength
of self-adhesive cements.110-113 Ultimately, resin-based cements Funding
produce higher long-term tensile bond strengths than self- The author(s) received no financial support for the research, author-
adhesive resin-based cements.114-116 Self-adhesive resin-based ship, and/or publication of this article.
cements can be self-cured, light cured, or dual cured.
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