Cementation is the final step of indirect restorations which, usually, we do not take very seriously – until the patient comes back with a dislodged crown repeatedly and we don’t understand where we went wrong! There are two objectives for cementation or luting 1 –

to help retain the restoration in place and
for a good marginal adaptation and seal.

If you are one of the many who only use GIC in their clinic, then take a look at various cements available along with their leading brand names, primary advantages & disadvantages, indications with literature supported recommendations and you will be in for a pleasant surprise!

In this Article

Table 1. Overview of Cements 1,2

Cement Type	Leading Brand Names	Primary Strengths	Primary Weaknesses
Zinc Phosphate	Fleck’sTM	Long clinical experience	Occasional postoperative sensitivity, High solubility, Low hardness
Polycarboxylate	Durelon TM	Low fluoride ion release, Low postoperative sensitivity	High solubility ,Low adhesion, Low hardness
Conventional Glass Ionomer	Ketac TM Cem Fuji 1®	Fluoride ion release , Adhesion to tooth and metal Ease of use, Good routine cement	Occasional postoperative sensitivity, Some moisture sensitivity, Marginal solubility
Resin-Modified Glass Ionomer	RelyX TM Luting RelyX TM Luting Plus Fuji PLUS TM FujiCEM TM	Fluoride ion release , Adhesion to tooth and metal, Low or no marginal solubility, Ease of use, Low postoperative sensitivity , Good routine cement	Swelling or linear expansion , Moisture sensitive powder
Composite Resin Total Etch cement system Self – Etch Primer cement system Self-Adhesive Cement System	Variolink® II Calibra® C&B Metabond®. RelyX TM Veneer Cement Panavia RelyX TM Unicem Cement	High strength, Esthetics, Low solubility, High adhesion High strength, Low solubility, High adhesion, No etching required on dentin, Low postoperative sensitivity High strength, High adhesion, Esthetics, Ease of use, Low postoperative sensitivity, Low solubility , Easy clean up, Capsule delivery system	Technique sensitive, Requires use of separate etchant and/or primer and adhesives, Potential for postoperative sensitivity, Difficult clean up Difficult clean up, Separate primer required Limited clinical history, Available only in capsule delivery

Also read: Trauma and nerve damage to teeth (Part I)

Table 2. Indications Chart – Cement Recommendations 2,3,4

	Zinc Phosphate	Zinc Polycarboxylate	Conventional Glass Ionomer	Resin-Modified Glass Ionomer	Composite-Resin Cement
Metal or PFM crowns/bridge inlays/onlays/ SS pedo crowns/metal post	X1	X1	X1	X1	X 3
Composite crowns / inlays / onlays	__	__	__	__	X
All-zirconia or alumina strengthened crowns/bridges / Zr pedo crowns	__	__	X 2	X 2	X
Lithium Disilicate all ceramic crowns / inlays/onlays	__	__	__	__	X 4
Composite or ceramic laminates/ veneers/ fibre post	__	__	__	__	X 4,5
Implant restorations	X 6	X 6	__	__	X 6

1. Composite-resin cement should be used –

For Maryland bridges
If enough mechanical retention is not available (preparation height <3mm)

Zinc phosphate cements are not recommended for vital tooth preparations because of their acidic nature.

2. Composite-resin cement should be used –

If aesthetic and wear resistance needs are assessed and GI-based cements will be insufficient and do not complement the restoration.
If enough mechanical retention is not available (preparation height <3mm)

3. For most composite-resin cements, with the exception of some self-etching-based systems (i.e., RelyX Unicem), typically more work and effort is needed than for metal-based restorations that have sufficient built in retention. It also may increase the potential for patient sensitivity and difficulty in clean up and so must be handled with care.

4. Restorations made of ceramic materials must be preferably etched with hydrofluoric acid, silanated with silane coupling agent and then bonded to tooth structures.

5. Light-cure only systems are preferred to maximize potential for color stability. Self-cure systems or light-curable “base” components from dual-cure systems have greater potential for color change over time.

Special note– Cementation of provisional/transitional prosthesis.

Temporary crowns in conventional FPD or implant restorations are usually made of acrylic or composite. They are cemented with zinc oxide eugenol/non eugenol cements.

Eugenol cements are indicated for relief of pulpal sensitivity.

Non eugenol cements are used where subsequent reline and re-margination procedures maybe required or when final cementation is to be done with resin cement. This is because eugenol may inhibit the setting of the acrylic and resin when it is in unset state.

Table 3. Provisional cements

Eugenol cements	Non eugenol cements
TempoCem,Tempocem soft (DMG)	Nogenol, Freegenol (GC America)
Embonte, Embonte 2 (Dux Dental)	Zone (Dux Dental)
Flow-Temp (Premier Dental Products)	Integrity TempGrip (Dentsply Caulk)
TempBond (Kerr Corp.)	TempBond Clear (Kerr Corp.)
Trial Cement (Opotow Corp.)	ProvicolTempoCem NE (VOCO)
Rely X Temp E (3M ESPE)	RelyX Temp NE(3M ESPE)
Temrex ZOE plus (Temrex Corp.)	TempoSIL 2 (Coltene)

Also read: Case Report: Lifelike Restoration with Mineral Enriched Activa™ Pronto

Here, we conclude part 1 of this guide. Stay tuned for part 2 where we will discuss cementation protocols for different types of prostheses and special clinical tips & tricks!