Dental Materials Journal 2012; 31(1): 68–75

Radiopacity of different resin-based and conventional luting cements compared to human and bovine teeth
Gürel PEKKAN1 and Mutlu ÖZCAN2
1 2

Dumlupinar University, Faculty of Dentistry, Tavsanli Yolu 10. km, 43270 Kutahya, Turkey University of Zürich, Dental Materials Unit, Center for Dental and Oral Medicine, Clinic for Fixed and Removable Prosthodontics and Dental Materials Science, Plattenstrasse 11, CH-8032 Zürich, Switzerland Corresponding author,  Gürel PEKKAN;  E-mail:  gurelp@gmail.com 

This study evaluated the radiopacity of different resin-based luting materials and compared the results to human and bovine dental hard tissues. Disc specimens (N=130, n=10 per group) (diameter: 6 mm, thickness: 1 mm) were prepared from 10 resin-based and 3 conventional luting cements. Human canine dentin (n=10), bovine enamel (n=10), bovine dentin (n=10) and Aluminium (Al) step wedge were used as references. The optical density values of each material were measured from radiographic images using a transmission densitometer. Al step wedge thickness and optical density values were plotted and equivalent Al thickness values were determined for radiopacity measurements of each material. The radiopacity values of conventional cements and two resin luting materials (Rely X Unicem and Variolink II), were significantly higher than that of bovine enamel that could be preferred for restorations cemented on enamel. Since all examined resin-based luting materials showed radiopacity values equivalent to or greater than that of human and bovine dentin, they could be considered suitable for the restorations cemented on dentin. Keywords: Adhesion, Luting cement, Optical density, Radiopacity, Resin cement 

INTRODUCTION
All-ceramic restorations are becoming increasingly popular in dentistry due to their outstanding esthetics and high strength1). Especially for minimal invasive all-ceramic restorations such as inlays, onlays, laminates, adhesive cementation is a prerequisite. Resin-based luting materials considerably increase the resistance of all-ceramic restorations under occlusal loading2-6). Resinbonding also reduces microleakage compared to conventional cements7). In particular for esthetic anterior restorations, translucent ceramic materials are preferred where the choice of luting agent has a substantial influence on the outcome8). Expanded kits of resin cements with multiple shades are available deriving their shades and opacity from various fillers2,9). The color stability and thereby radiopacity of resin-based luting materials is also of great importance. Among many variables that affect the color stability of resin-based restorative materials or luting-agents, radiopaque fillers play a significant role10-12). While the amine accelerator necessary for dual polymerization may also cause color change of the luting agent over time13), photo-polymerizing resin-based luting materials are preferred due to their color stability14,15). Non-metallic inlays, onlays, all-ceramic crowns and fixed dental prosthesis (FDP) are typically cemented using dual polymerized resin cements3-5,16,17). On the other hand, chemically polymerizing resin cements are advised for the cementation of prefabricated posts, radiolucent non-metallic posts, carbon-fiber posts, gold inlay/onlay restorations, metallic crowns and FDPs17,18). Radiopacity is an important feature of esthetic resin-based luting materials18,19). It is essential that such
Received Mar 25, 2011: Accepted Sep 14, 2011 doi:10.4012/dmj.2011-079 JOI JST.JSTAGE/dmj/2011-079

materials be sufficiently radiopaque to permit detection of marginal overhangs, open gingival margins, as well as recurrent caries in the gingival areas18,20,21). When the luting agent is not radiopaque enough, it is impossible to detect excess luting agent or caries radiographically20). Ideally, restorative materials should have radiopacity values equivalent to or greater than that of dentin22-25). Previous studies used different methods to evaluate the radiopacity of dental materials26-30). In fact, the International Organization for Standardization (ISO) has published radiopacity evaluation protocol and set guidelines for radiopacity of polymer-based filling, restorative and luting materials31). According to the protocol, the radiopacity of a dental material is expressed as optical density value or in terms of equivalent aluminium (Al) thickness (in millimeters) using a reference calibration curve under controlled radiographic conditions32). Consequently, such materials should have radiopacity level equal to or greater than that of Al32). Filler type and amount of radiopaque fillers may influence the radiopacity of resin-based materials33). Although filler type does not affect the degree of conversion and polymerization shrinkage of resin composites, the radiopaque particles increase the thermal expansion, hydrolyze the silane bonding agent, and cause opacity12). Quartz and silica fillers on the other hand are not radiopaque. Therefore, it can be anticipated that cements containing such fillers would present less radiopacity compared to those of conventional cements. Some of these resin cements are available in different shades. Since primarily the composition of the cements remains the same, no significant difference could be expected between different shades. Radiopacity level of conventional or resin-based cements may influence the

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detection of caries or the evaluation of integrity of the restoration margins. From clinically and biological standpoint, radiopacity level of cements in relation to dentin and enamel could influence choice of cements for tooth-colored indirect restorations. The purpose of this study was to evaluate the radiopacity of different resin-based luting materials, conventional cements and compare the values to those of human and bovine dental hard tissues and Al step wedge, as the control. The hypothesis tested were that a) resin-based luting cements containing glass particles would show similar radiopacity values, b) resin cements would present less radiopacity compared to conventional cements, and c) different shades of resin cements would show similar radiopacity values.

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MATERIALS AND METHODS
Specimen preparation Disc specimens (N=130, n=10 per group) (diameter: 6 mm, thickness: 1 mm) were prepared from from 10 resin-based and 3 conventional luting cements. The

thickness of the secimens were set to 1 mm in accordance with the ISO Standard 404931). The materials, their chemical compositions, manufacturers and batch numbers are listed in Table 1. Cements were mixed according to each manufacturer’s instructions and compressed between two glass slides in the mold during photo-polymerization (Hilux Ledmax 1040, Darphie Ltd., Bangkok, Thailand). All materials were polymerized for 40 s from a constant distance of 2 mm from the surface. Light output was minimum 500 mW/cm2 measured with a radiometer (Hilux Ledmax 1040) after every 10 specimens. All specimens were ground finished to 400-grit silicon carbide paper (Struers, Willich, Germany) under water to create flat surfaces. Thickness of the specimens was measured with a digital caliper (Youfound Precision Co. Ltd, Zhejiang, China) with a critical tolerance of 1±0.01 mm. All specimens were ultrasonically cleaned in distilled water for 5 min (Eurosonic 4D, Euronda S.p.A., Vicenza, Italy). All specimens were then kept in distilled water at 37°C for 24 h. Samples of human canine dentin (n=10), bovine dentin (n=10), bovine enamel (n=10) were

Table 1  Brands, shades, manufacturers, chemical compositions of the materials investigated in this study Brands and shades Panavia F TC (PFT) Chemical composition**, Batch number Paste A: 10-MDP, hydrophobic and hydrophilic dimethacrylate, benzoyl peroxide, camphoroquinone, colloidal silica Paste B: Sodium fluoride, hydrophobic and hydrophilic dimethacrylate, diethanol-p-toluidine, T-isopropylic benzenic sodium sulfinate, barium glass, titanium dioxide, colloidal silica Batch no: Paste A: 00222A Paste B: 00122 Variolink II Universal dualpolymerized (VLD) Base: Bis-GMA, UDMA, TEGDMA, benzoyl peroxide, Ba-Al- Flurosilicate glass, stabilizers, pigments Catalyst: Ytterbium trifluoride, dimethacrylates, inorganic fillers, Bis-GMA, dl-camphorquinone, stabilizers, pigments Base: monomer 26.3 wt%, filler 73.4 wt% Catalyst high viscosity: monomer 22 wt%, filler 77.2 wt% Batch no: 58561 Variolink II Universal Photopolymerized (VLL) Nexus 2 (NXS) Base: monomer 26.3 wt%, filler 73.4 wt% Catalyst high viscosity: monomer 22 wt%, filler 77.2 wt% Batch no: 58561 Ivoclar Vivadent AG, Schaan, Liechtenstein Ivoclar Vivadent AG, Schaan, Liechtenstein Manufacturer Kuraray Medical Inc., Okayama, Japan

Bis-GMA, 70 wt%, 47 wt % inorganic filler, average particle size: 0.6 µm Batch no: Base: 403996 Catalyst: 406257 Bis-GMA (5–30 wt%), TEGDMA (5–20 wt%), UDMA (5–15 wt%, base only), glass filler (50–80 wt%) Batch no: 0400003526

Kerr Corp., Orange, CA

Duolink (DL)

Bisco Inc, Schaumburg, IL

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Table 1 (continued)

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Brands and shades Rely X Unicem Aplicap A2 (RX2)

Chemical composition**, Batch number Powder: Silanized glass powder 85–95 wt%, silane treated silica 5–10 wt%, calcium hydroxide 1–5 wt%, substituted pyrimidine 1–5 wt%, sodium persulfate <1 wt% Liquid: Methacrylated phosphoric acid esters 40–50 wt%, TEGDMA 25–35 wt%, substituted dimethacrylate 22–34 wt% Batch no: 258548

Manufacturer 3M ESPE AG, Seefeld, Germany

Rely X Unicem Aplicap A3 (RX3)

Powder: Silanized glass powder 85–95 wt%, silane treated silica 5–10 wt%, calcium hydroxide 1–5 wt%, substituted pyrimidine 1–5 wt%, sodium sulfate <1 wt% Liquid: Methacrylated phosphoric acid esters 40–50 wt%, TEGDMA 25–35 wt%, substituted dimethacrylate 22–34 wt% Batch no: 258548

3M ESPE AG, Seefeld, Germany

Rely X Unicem Aplicap Translucent (RXT)

Powder: Silanized glass powder 85–95 wt%, silane treated silica 5–10 wt%, calcium hydroxide 1–5 wt%, substituted pyrimidine 1–5 wt%, sodium sulfate <1 wt% Liquid: Methacrylated phosphoric acid esters 40–50 wt%, TEGDMA 25–35 wt%, substituted dimethacrylate 22–34 wt% Batch no: 258548

3M ESPE AG, Seefeld, Germany

Rely X ARC, Universal A3 (RAC3)

Paste A: Silane-treated silica, TEGDMA, Bis-GMA, functionalized dimethacrylate polymer Paste B: Silane-treated ceramic, TEGDMA, Bis-GMA, silane treated silica, functionalized dimethacrylate polymer Batch no: FLGH

3M ESPE AG, Seefeld, Germany

Paste A: Silane-treated silica, TEGDMA, Bis-GMA, functionalized Rely X ARC, Transparent A1 dimethacrylate polymer Paste B: Silane-treated ceramic, TEGDMA, Bis-GMA, silane treated silica, (RAC1) functionalized dimethacrylate polymer Batch no: EYGH Ketac Cem Easymix glass ionomer luting cement (KCE) Adhesor Carbofine Zinc polycarboxylate cement (ZNC) Adhesor Zinc phosphate cement (ZNP) Powder: Glass powder, polycarboxylic acid, pigments Liquid: Water, tartaric acid, conservation agents Batch no: Powder: 241231 Liquid: 235634 Powder: Oxides (Zn, Mg, Al), boric acid Liquid: Acrylic acid, maleic acid anhydride, distilled water Batch no: Powder: 1726657 Liquid: 1700128 Powder: Zinc oxide, magnesium oxide, aluminium trihydroxide, boron trioxide Liquid: “Normal” aqueous solution of phosphoric acid and aluminium orthophosphate and “Rapid” aqueous solution of phosphoric acid, aluminium orthophosphate and zinc orthophosphate Batch no: Powder: 1399466 Liquid: 1382770-2

3M ESPE AG, Seefeld, Germany

3M ESPE AG, Seefeld, Germany

Spofa Dental a.s., Prague, Czech Republic

Spofa Dental a.s., Prague, Czech Republic

*MDP: 10-Methacryloyloxydecyl dihydrogen phosphate; TEGDMA: Triethyleneglycol dimethacrylate; Bis-GMA: bisphenolA-diglycidyl methacrylate; UDMA: urethane dimethacrylate; HEMA: 2-Hydroxyethyl methacrylate. **All information is obtained from material safety sheet data of the products tested.

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Fig. 1 One specimen from each test material, bovine dentin and enamel, a human canine slice and Al step wedge positioned on an occlusal radiograph.

Fig. 2 Representative developed radiograph with all specimens. Canine tooth (left), (top row) KCE, RX2, RAC1, RXT, ZNC; (second row) VLD, DL, PFT, RX3, BE; (bottom row) NXS, RAC3, VLL, ZNP, BD; Al step wedge.

used as reference of radiopacity, whereas an Al step wedge was used to internal control of radiopacity. Ten enamel and dentin disk specimens were prepared from mandibular bovine incisors (diameter: 6 mm, thickness: 1 mm) by longitudinal sectioning of the buccal side of the teeth after separating the roots. Longitudinal sections of human dentin were also prepared to the same thickness using a micro-slicing device (Accutom, Struers Co, Copenhagen, Denmark). Radiopacity analysis An Al step wedge was machined from a single Al block (Alu-Keil, PEHA Medikal Geräte GmbH, Sulzbach, Germany) using electrical discharge machining technique. The maximum thickness of the step wedge was 8 mm where each step had a thickness of 1 mm, length of 4 mm, and width of 14 mm. The Al step wedge was used to internal control of radiopacity. One specimen of each material, bovine enamel, bovine dentin and human dentin and an Al step wedge were positioned side by side on occlusal D speed radiographic film (Kodak Ultra-speed, Eastman Kodak Company, Rochester, NY) (Fig. 1). A special holder was mounted to ensure a fixed focus/film distance. The films were exposed for 0.38 s with a dental X-ray system (Trophy, Vincennes, France) at 70 kV and 8 mA where the object-to-film distance was 30 cm. All films were processed immediately in a standard automatic processor (Velopex Extra-X, Medivance, Harlesden, UK) using fresh developer and fixer (Velopex Ready Mixed Developer and Fixer, Hexagon International Ltd, Berkhamsted, UK) (Fig. 2). The optical densities of the radiographic images were measured with a transmission densitometer (Pehamed Denso-Dent Densitometer, PEHA Medikal Geräte GmbH, Sulzbach, Germany). Means of at least 3 readings per specimen was measured with an aperture size of 3 mm (DIN 6868/55). Following the method previously described elsewhere23), a graph were plotted to illustrate the relationship between the

Fig. 3 Optical density calibration curves for Al step wedge thickness.

step wedge thickness and optical density values with the following equation: [y=−0.5296Ln(x)+2.1971]. From that graph, optical density values of the specimens were used to determine the equivalent Al thickness (eq Al) values (Fig. 3). Statistical analysis Statistical analysis was performed using SPSS 13.0 for Windows (SPSS Inc., Chicago, IL). Data were analyzed using one-way analysis of variance (ANOVA), KruskalWallis and Student-Newman-Keuls multiple range tests (=0.05).

RESULTS
Significant difference was observed between radiopacity values of the tested materials (Kruskal-Wallis) (p<0.0001) (Table 2). Among conventional cements, zinc phosphate cement showed the highest radiopacity (p<0.0001) (7.845±1.011) followed by zinc polycarboxylate (6.290±0.379) and glass-ionomer (1.808±0.258). From

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Table 2  Means and standard deviations (SD) of optical density and equivalent Aluminium (Al) step wedge thickness values of the tested materials, human dentin (HD), bovine dentin (BD) and bovine enamel (BE) and statistical differences between groups. See Table 1 for material coding. Material code HD BD PFT DL NXS RAC3 RAC1 BE KCE RX2 RX3 RXT VLD VLL ZNC ZNP Optical density values (Mean±SD) 2.084±0.086 2.039±0.067 2.007±0.062 1.999±0.078 1.925±0.081 1.910±0.071 1.898±0.065 1.888±0.072 1.888±0.071 1.806±0.052 1.788±0.061 1.773±0.068 1.457±0.065 1.418±0.048 1.224±0.031 1.110±0.067 Equivalent Al Step wedge values (Mean±SD) 1.254±0.220 1.358±0.174 1.441±0.178 1.469±0.235 1.690±0.279 1.734±0.248 1.772±0.233 1.808±0.262 1.808±0.258 2.102±0.208 2.178±0.259 2.245±0.305 4.072±0.502 4.371±0.410 6.290±0.379 7.845±1.011 Statistical differences* A A,B B,C C D D D D D E E E F F G H

*The same letters in the column indicate no significant differences according to Student-Newman-Keuls multiple range tests (p<0.05).

conventional cements only zinc phosphate and zinc polycarboxylate showed significantly higher radiopacity compared to bovine enamel (1.808±0.262). All conventional cements tested showed significantly higher radiopacity than those of human dentin (1.254±0.220) and bovine dentin (1.358±0.174) (p<0.0001) both of which were not significant (p>0.05). All resin based luting materials (1.441±0.178– 4.371±0.410) showed similar to or significantly higher radiopacity values than those of human and bovine dentin. The radiopacity values of resin luting materials Rely X Unicem (2.102–2.245) and Variolink II (4.072–4.371) were significantly higher than that of bovine enamel (1.808±0.262) being also significant from each other.

DISCUSSION
Radiopacity of a material can be simply defined as the inverse of the optical density of a radiographic image. Optical density value is a logarithmic measure of the ratio of the transmitted-to-incident light through the film image, measured by the transmission densitometry. Optical density values depend not only on the inherent X-ray absorption properties of the materials, but also on the characteristics of the film (fog and base density), its exposure parameters, and processing conditions34). Therefore, in this study, the equivalent Al thickness values were also calculated in order to compare the results with a reference material. In this study, the

results were also compared to human dentin, bovine enamel and bovine dentin. Bovine enamel and dentin were used as it was reported to present similar morphological and histological properties compared to human teeth17,27). Bovine teeth also permitted to make disc-shaped enamel specimens of 1 mm in thickness and 6 mm in diameter that was technically not possible with the human teeth. Since the aperture of the transmission densitometer was 3 mm in diameter, it allowed for the measurement of an area of 7 mm2. For this reason, disks with a diameter of 6 mm were obtained from the enamel of bovine mandibular incisor which was not possible in human enamel27). It was previously reported that density of a radiopaque resin-based materials should be more than that of dentin and similar to or slightly higher than that of enamel12). The use of materials with radiopacity close to or less than dentin may result in diagnostic challenges25). Conversely, too much radiopacity as in amalgam, can interfere with the detection of voids and recurrent caries and consequently, diagnostic discrimination in areas covered by the restoration may decrease32). A radiopacity slightly greater than that of enamel assist in distinguishing between restorations and carious affected or infected tooth structure as well as determining homogeneity of the luting cement35). According to the results of this study, considerable differences were observed between the radiopacity values of resin-based luting materials tested. Those of the cements containing similar filler types showed

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significant differences. Therefore the first hypothesis could be rejected. All materials had radiopacity values equivalent to or greater than that of human and bovine dentin. Since significant differences in mean radiopacity values were observed between the conventional and resin-based luting materials, the second hypothesis was accepted. On the other hand, as anticipated, cements of the same kind with different shades did not show significant differences yielding to acceptance of the third hypothesis. The radiopacity values were compared to bovine dentin and human dentin both of which did not show significant differences from one another indicating that bovine dentin could substitute human dentin with its similar morphological and histological characteristics36). Variability in radiopacity values reported in different studies could be attributed to many factors. Resin composites are typically composed of inorganic fillers dispersed in a resin matrix10,12). The radiopacity of a resin-based material depends in part on selection of the polymer matrix, chemical nature of the filler particles, their size, density and an amount in the resin matrix10,11). While resin matrices such as bisphenol-A-glycidyl methacrylate (Bis-GMA), urethane dimethacrylate (UDMA), 10-methacryloyloxydecyl dihydrogen phosphate (MDP), triethyleneglycol dimethacrylate (TEGDMA), 2-hydroxyethyl methacrylate (HEMA) contribute little to the radiopacity of the material, it is typically the inorganic filler component that contributes most to the radiopacity of resin-based luting materials2,18). However, the findings of this study clearly indicate that both MDP and HEMA could have influenced radiopacity values as the inorganic filler types were similar in these resin cements. The effect of the matrix type on the radiopacity of resin cements requires further investigations. In resin-based materials, barium, yttrium, ytterbium, zinc, aluminium, strontium, and zirconium are additives that increase radiopacity10,37). Among the tested resin cements, dual-polymerized and photopolymerized Variolink II presented radiopacity values significantly higher than that of bovine enamel. Both of these cements showed similar radiopacity that could be attributed to the composition of the catalyst that gives the radiopacity to both dual and photo-polymerizing cements. The filler content (ytterbium trifluoride) was also similar in these two cements possibly being responsible from similar radiopacity values obtained18,19). As expected, different shades of self-adhesive cement, Rely X Unicem and Rely X ARC, also did not show significant differences since the major effect in the shades are obtained from oxides, which probably did not interfere with the overall radiopacity. Although the filler content was higher than that of Variolink II, radiopacity was significantly less than those of Variolink II dual and photo-polymerized cements. The difference could be due to the high content of glass particles (85–95 wt%) in Rely X Unicem according to the manufacturer’s information. When conventional cements are compared, the higher radiopacity of zinc polycarboxylate and zinc phosphate more than glass-ionomer could be explained with the

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magnesium oxide and to glass ionomer, fluoroaluminosilicate glass and barium filler particles, contributing to the radiopacity. Although radiolucent resin-based luting agents may have optical advantages, the overhangs may not be controlled properly and recurrent decay may not be detected. Their use should be particularly contraindicated in situations where the margins are located in areas that have difficult access25). In an in-vitro study, excess cement could not be detected in association with radiopaque resin composite inlays, even with the most radiopaque materials, but they could be detected easier adjacent to radiolucent porcelain inlays21). The use of radiopaque resin-based luting materials is therefore especially important in combination with radiolucent restorations such as ceramic laminate veneers, inlays, onlays and fiber posts or in restorations with subgingivally located margins18,20,22). Although, postcementation protocols do not presently include routine radiographic examination, inaccurate removal of cement excess may lead to periodontal problems30). Particularly when cement film thickness is less than 25–50 µm after cementation, it is favourable to use the highest radiopaque cement possible in order to be detected easily in the radiographs21,33). Radiographic density is directly obtained from digital image analysis. The pixels already available in grey shades provide the values straight at a scale of 0 to 255 through the sofware38). For this reason, direct or indirect digital image analysis is considered as a fast and easy resource for interpreting radiographic density of the restorative materials in dental practice38). The advantages of direct digital systems are immediate image capture, lack of processing chemicals and high sensitivity to radiation exposure39). Although direct or indirect digital dental radiology systems are preferred to study the radiopacity of a material due to low irradiation dose, instant image, image manipulation, the X-ray film technique is widely used by researchers and manufacturers and it is still considered as a golden standard technique18,26,34). Hence, the choice between direct and indirect digital image analysis and transmission densitometry requires further investigations. Variation in radiopacity measurements of the same restorative materials among different studies depends on a number of factors, including speed of the X-ray film, exposure time, voltage used and the age of the developing and fixing solutions23). Furthermore, source-film distance, intensifying screens, grids and specimen thickness are also among factors that affect the radiopacity values. Among resin cements, although the radiopacity of Variolink II was the highest in this study and in previous studies18,19), the equivalent Al values were different. While Rubo and El-Mowafy18) used 2.5 mm thick specimens with focus-object distance of 40 cm at 65 kV, Tsuge19) used 2.3 mm thick specimens and focus-object distance of 35 cm at 60 kV. In this study, object-to-film distance was 30 cm at 70 kV. ISO standards require the minimum radiopacity of restorative materials be equal

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materials. Bull Hist Dent 1993; 41: 111-115. 10) Bowen RL, Cleek GW. A new series of x-ray-opaque reinforcing fillers for composite materials. J Dent Res 1972; 51: 177-182. 11) Chandler HH, Bowen RL, Paffenbarger GC, Mullineaux AL. Clinical investigation of a radiopaque composite restorative material. J Am Dent Assoc 1970; 81: 935-940. 12) Amirouche-Korichi A, Mauzali M, Watts DC. Effects of monomer ratios and highly radiopaque fillers on degree of conversion and shrinkage-strain of dental resin composites. Dent Mater 2009; 25: 1411-1418. 13) Brauer GM, Dulik DM, Antonucci JM, Termini DJ, Argentar H. New amine accelerators for composite restorative resins. J Dent Res 1979; 58: 1994-2000. 14) Berrong JM, Weed RM, Schwartz IS. Color stability of selected dual-cure composite resin cements. J Prosthodont 1993; 2: 24-27. 15) Noie F, O’Keefe KL, Power JM. Color stability of resin cements after accelerated aging. Int J Prosthodont 1995; 8: 51-55. 16) Sorensen JA, Kang SK, Avera SP. Porcelain composite interface microleakage with various porcelain surface treatments. Dent Mater 1991; 7: 118-123. 17) Soares CJ, Mitsui FH, Neto FH, Marchi GM, Martins LR. Radiodensity evaluation of seven root post systems. Am J Dent 2005; 18: 57-60. 18) Rubo MH, El-Mowafy O. Radiopacity of dual-cured and chemical-cured resin-based cements. Int J Prosthodont 1998; 18: 70-74. 19) Tsuge T. Radiopacity of conventional, resin-modified glass ionomer, and resin-based luting materials. J Oral Sci 2009; 51: 223-230. 20) Goshima T, Goshima Y. Radiographic detection of recurrent carious lesions associated with composite restorations. Oral Surg 1990; 70: 236-239. 21) O’Rourke B, Walls AW, Wassell RW. Radiographic detection of overhangs formed by resin composite luting agents. J Dent 1995; 23: 353-357. 22) Tveit AB, Espelid I. Radiographic diagnosis of caries and marginal defects in connection with radiopaque composite fillings. Dent Mater 1986; 2: 159-162. 23) El-Mowafy OM, Brown JW, McComb D. Radiopacity of direct ceramic inlay restoratives. J Dent 1991; 19: 366-368. 24) Finger WJ, Ahlstrand WM, Fritz UB. Radiopacity of fiberreinforced resin posts. Am J Dent 2002; 15: 81-84. 25) Attar N, Tam LE, McCamb D. Mechanical and physical properties of contemprorary dental luting agents. J Prosthet Dent 2003; 89: 127-134. 26) Gürdal P, Akdeniz BG. Comparison of two methods for radiometric evaluation of resin-based restorative materials. Dentomaxillofac Radiol 1998; 27: 236-239. 27) Fonseca RB, Haiter-Neto F, Fernandes-Neto AJ, Barbosa GAS, Soares CJ. Radiodensity of enamel and dentin of human, bovine and swine teeth. Arch Oral Biol 2004; 49: 919-922. 28) Sabbagh J, Vreven J, Leloup G. Radiopacity of resin-based materials measured in film radiographs and storage phosphor plate (Digora). Oper Dent 2004; 29: 677-684. 29) Rasimick BJ, Gu S, Deutsch AS, Musikant BL. Measuring the radiopacity of luting cements, dowels, and core build-up materials with a digital radiography system using CCD sensor. J Prosthodont 2007; 16: 357-364. 30) Wadhwani C, Hess T, Faber T, Pineyro A, Chen CS. A descriptive study of the radiographic density of implant restorative cements. J Prosthet Dent 2010; 103: 295-302. 31) International Standards Organisation. ISO 4049. Dentistrypolymer-based filling, restorative and luting materials, 3rd ed. 2000. 32) Watts DC, McCabe JF. Aluminium radiopacity standards for

to or greater than that of an equivalent thickness of Al31). Although the radiopacity of dentin and enamel specimens varies, pure Al provides a constant reference value32). In this present study, all materials had greater equivalent thickness of Al, indicating that they all fulfilled the ISO requirements. One limitation of this study was that the oral environment was not simulated. In the oral environment factors such as oral fluids, soft tissues and the surrounding dental structures may affect the radiopacity levels of restorative materials in that low density restorative materials become more visible on a radiograph when the soft tissue and hard dental structures are superimposed. Furthermore, leakage of ions from silicone, barium, strontium, and sodium filler particles into the aqueous medium may result in reduced radiopacity40). Future studies are warranted to study the radiopacity of luting cements after aging.

CONCLUSIONS
All examined resin-based luting materials showed radiopacity values equivalent to or greater than that of human and bovine dentin but not necessarily higher than that of bovine enamel. Due to the higher radiopacity values of conventional cements and Rely X Unicem and Variolink II resin cements than that of bovine enamel, they could be preferred for restorations cemented on enamel. Since all examined resin-based luting materials showed radiopacity values equivalent to or greater than that of human and bovine dentin, they could be considered suitable for the restorations cemented on dentin.

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