Luting and Cementation Challenges in a Dental Practice

The Role of Luting and Cementing in Dentistry

Luting agents, or cements, are materials used to affix restorations such as crowns, bridges, and inlays to natural teeth. They are a vital part of dentistry and you need a solution you can trust. But what can make luting and cementing such a challenge?

Critical Variables:

• Cement viscosity and its impact on handling.
• Pre-treatment of the restoration’s fit surface.
• Working and setting times of cements in clinical practice.
• Ease of cement cleanup post-application.
• Shade selection and compatibility with the underlying tooth colour.

Any one of these can create pain points for dentists, either affecting the quality of the procedure, or exacerbating the time needed.

Simplification and getting back to the basics of what you need from your luting cement can help to solve all of these problem.

Challenges and Solutions: Luting Cements

Restorations Are Not Always Retentive

When Luting CADCAM Restorations It Can Be Difficult To Control The Thickness

This can affect the fit of the restoration and therefore its efficacy. In some extreme cases, the design can be difficult to mill making the adaptation critical in the inner part of the indirect restoration. This leads to increased thickness of the cement layer, which in turn increases the shrinkage stress of the cement which can lead to cement peeling and debonding from the tooth surface.

This is illustrated by a paper published in 2016 in the Japanese Society for adhesive dentistry. GC’s solution is again the optional tooth primer called AEP which delivers touch cure technology on the surface of the tooth.

Choosing The Right Luting Cement

In modern restorative dentistry, achieving optimal retention and durability for fixed prostheses is a critical aspect of successful treatment outcomes. With the advent of advanced materials like zirconia and lithium disilicate, the selection of the correct luting cement is more crucial than ever.

But what are the different luting cements, and what is the difference between them?

Resin-Modified Glass Ionomer Cements (RMGICs) such as Fuji Plus

Resin-modified glass ionomer cements are an excellent choice for luting both zirconia and lithium disilicate restorations. These cements combine the traditional advantages of glass ionomer cements—such as fluoride release and biocompatibility—with the improved physical properties of resin-based materials.

For zirconia restorations, RMGICs offer several advantages:

Chemical Bonding: RMGICs chemically bond to the tooth structure, providing retention even in cases where mechanical retention is not sufficient.
Fluoride Release: The fluoride-releasing property of RMGICs can help prevent secondary caries around the restoration, especially important in patients with high caries risk.
Ease of Use: RMGICs are less technique-sensitive compared to other resin-based cements, making them a good choice for clinicians looking for a reliable solution in restorative procedures.

A simple definition of CAD/CAM dentistry is the use of digital software to design and manufacture dental restorations and prostheses. CAD stands for computer-aided design and CAM stands for computer-aided manufacturing. The technology can be used to create crowns, dentures, inlays, onlays, bridges and veneers among other things. The speed of the CAD/CAM process allows for dental prosthetics to be designed, manufactured and delivered to the patient in quick time, sometimes the same day. The wider system of using computer assisted technologies to produce restorations is known as CEREC (Chairside Economical Restoration of Aesthetic Ceramics).

Self-Adhesive Resin Cements such as G-CEM One

Self-adhesive resin cements are another popular choice for luting both zirconia and lithium disilicate restorations. These cements are designed to eliminate the need for separate etching or priming steps, simplifying the bonding process and saving time in the dental office.

For Zirconia: Self-adhesive resin cements are often the material of choice due to their superior bond strength and ease of use. While zirconia requires surface treatment (e.g., sandblasting or applying a primer), the self-adhesive resin cement will provide a strong mechanical bond. These cements offer excellent retention and are particularly effective in cases where the preparation is well-designed to maximise retention.
For Lithium Disilicate: Self-adhesive resin cements are equally effective for lithium disilicate restorations. While lithium disilicate has an inherently stronger bond to resin cements, using a self-adhesive resin cement simplifies the procedure without compromising bond strength or longevity.

Self-Adhesive Resin Cements such as G-CEM One

For Zirconia: Self-adhesive resin cements are often the material of choice due to their superior bond strength and ease of use. While zirconia requires surface treatment (e.g., sandblasting or applying a primer), the self-adhesive resin cement will provide a strong mechanical bond. These cements offer excellent retention and are particularly effective in cases where the preparation is well-designed to maximise retention.
For Lithium Disilicate: Self-adhesive resin cements are equally effective for lithium disilicate restorations. While lithium disilicate has an inherently stronger bond to resin cements, using a self-adhesive resin cement simplifies the procedure without compromising bond strength or longevity.