Focus On Dentat Reseauce Physical Properties and Comparative Strength of a Bioactive Luting Cement Steven Jefferies, DDS, PhD; Jesper Ldéf, PhD; Cornelis H. Pameijer, DMD, MScD, DSc, PhD; Dan Boston, DMD; Colin Galbraith, DMD; and Leif Hermansson, AB, PhD Abstract— New dental cement formulations require testing to determine physical and mechanical laboratory properties (OBJECTIVES: To estan experimental calcium shuminat glass-ionomer cement, Ceramir* CRB (CCB), reguning compressive strength (C), film thickness (FT), net setting time (ST) and Viekershardness. An additional test toevalate potential dimensional change/expansion properties of this cement wasalso conducted. METHODS AND MATERIALS: CS was measured according toa slighty modified 180 9917:2003 for the CC&B specimens, The samples were not clamped while being exposed to relative humidity 63f290% at 37°C for T0 minutes before beingstored in phosphate-butfered saline at 37°C. Forthe CS, four groups were teste: Group 1-CC&B; Group 2 -RelyX" Luting Cement; Group 3 Fuji Plus: and Group+—RelyX° Unicem. Samples fromall groups were stored for 24 hows before testing Only CCB was tested forSTand FT accordinuto 1S0 9917-2008 The PT was tested 2 minutes s Indentation Tester using zine phosphate cement after mixing, Vickers hardness was evaluated using the CSM Microburdin ‘asa comparison material, Expansion testing Included! evaluating potential cracks in feldspathic porcelain jacket erowns (PIC: RESULTS:’The mean and standard deviation after 24 hours were expressed in MPa: Group 1 = 160 = 27; Group 2 = 96 +10;Group = 198 = 15;Group 4 ~157 = 10, Asingle-factor ANOVA demonstrated statistically significant differences between the groups (P < (0.001). Pair-avise statistical comparison demonstrated a statistically significant difference between Groups | and 2, No statistically significant differences were found between other groups. The FT was 168 = 0.9 um andl the ST was 4.8 + 0.1 min, Vickers hardness for Ceramir C&R was 68.3 17:2:and was statistically sign} £10, There was no evidence of cracks due to radial expansion in PJCsby the Ceramir C&B cement, CONCLUSION: 0) requirement for water-based cements of no hardness of All luting cements tested demonstrated compressive strengths well in excess of the less than 50 MPa, Ceramir C&B showed significantly higher CS than RelyX Luting Cement after 24 hours, but was not significantly higher than either Fuji Plus or RelyX Unicem, The ST and FT values of CC&B conlorm to and are within the boundaries of the requirements ofthe standard, Surface hardness was statistically higher than and comparable Lo zine phosphate cement. There was no evidence of potentially clinically significant and deleterious expansion behavior by this cement, All cements tested demonstrated acceptable strength properties, Within the limits ofthis study, Ceramir C8 is deemed to possess physical properties suitable fora dental luting cement, Keywords: dental cement, cementation, lting cement, bioactive, crowns, bridges, gold entallutingcements perform the critical fune- tion of forming a stable interface between fixed restoration and supporting tooth struc- ture. Although not directly exposed to the oral environment, except in marginal areas ofthe restoration, dental luting cements can undergo sign stresses and effects from masticatory forces due to thenature of the environment in the oral cavity, Mechanical proper tics of various luting cements can differ considerably, and, hence, evaluation and documentation of these properties is necessary. The suecess of fixed restorations toa lange extent depends on the type of luting agent used. Bioeompatibility, insolubility, and resistance against degradation are require- ‘ments that maintan the seal at the margins of Ue resto tions, which prevents ingress of bacteria that leads to leakage, ivity. and secondary deeay Luting cements have progressed over the years through icant various chemistries, namely: zinc phosphate, polycarbox- ylate, glass ionomer, resin, resin-modified glass-ionomer (RMGI) cements, and self-adhesive resin cements. Each of these cement (ypes or classifications possesses unique chemical characteristics, physical properties, and even, in some instances, potential therapeutic properties. \ recently developed cement formulation consists of a hybrid calcium aluminate/glass-ionomer cement. ‘This cement, Ceramir® C&B (CC&M) (Doxa Dental AB, www, ceramiruscom), isa new dental luting agent intended for permanent cementation of crowns and bridges, gold inlays, and onlays, prefabricated metal and cast post and cores, and all-zirconia or all-alumina crowns. The cement is a water-based composition comprising calcium aluminate and glass-ionomer components, and has been demonstrated tobe bioactive” Itis well recognized that any new luting cement (or for that November/Decener2018 + Volume $4 Special lesue 8Jerrentes: matter, any new dental material) should be characterized byanumber of laboratory physical and mechanical tests to ‘elucidate that material's physical properties. Therefore, the objective ofthisexperimental study was to test CC&B regard ing net setting time, film thickness, and compressivestrength according to International Organization for Standardization ({S0) 9917-1 (Water based cements ~ Part |: Powder/Liquid acid-base cements): Three other commercially available ce- ments were alsosubjected to compressive-strength testingfor ‘comparison tothe testeement, Viekerssurface hardness anda laboratory clinical simulation test to assess potential effects of cementdimensional changeand expansion were also included inthis testing The hypothesis or experimental question posed concerned whether the calcium aluminate /glass-ionomer cement would display physical properties equal to or better than current test standards for water-based cements, and similar tocurrent physical propertieslisplayed by other types ofluting cements Methods and Materials Conpntssive S a“ he compressive strength of CC&B lutingeement was mea- sured according to 180 9917:1(2003), Annex D, with aminor modification (ISO 9917-1, 2003).! (The modification was that the CC&B test material, while still in the stainless-steel ‘mold duringsetting, was maintained in 100% humidity during carly setting [a step not listed in the ISO test method] due to the fact that itis a hydraulic cement and sets optimally in a somewhat moist orhigh humidity environment during initial setting.) Information concerning the cements included in this compressive-strength testing is provided in Table 1 Specimens 6 mm in height and 4 mm in diameter were preparedasperthe sponsors directions for dispensingand mix- ing. CC&B powderand liquid were used ata liquid-to-powder ratio of 7 drops of liquid to 1 premeasured vial of powder (mass powder liquid ratio of 8.2). Prior to opening the glass. LOOP = Pamewen © Bosros » Gauprarnit ss HinMaxssox powder vial, it was lightly tapped with « metal hand instru ment to ensure that the powder was free-flowing and could completely be dispensed from the vial. After mixing the powder and liquid for approximately 30 to 85 seconds (45 seconds maximum), the split eylindrical Teflon-coated stainless-steel molds were filled with the mixed cement material, covered ‘with coated mixing pad paper, and placed ina humid envi ronment at 37°C for 10 minutes, The mold was opened, the era a CE SESS Mechanical properties of various luting cements can differ considerably, and, hence, evaluation and documentation of these properties Is necessary. specimens were lightly polished! to ereate lat uniform are and the specimens were placed in phosphate-buffered saline (PBS) for 24 hours. The 24-hour specimens were removed and tested in an Instron” (Model #5569) Universal Testing Machine (Instron Industrial Products, www:insteon.com) with, {4 50-KN load cell (series 2525) under compressive load at a strain-rate of0.75 mm/m, Control materials—RelyX Luting Cement (9M ESPE, www.8MESPE.com), RelyX™ Unicem Aplicap™ (8M ESPE), and Fuji Plus™ (GC America, www. ‘gcamicrica.com)—were dispensed and mixed according to the manufacturers’ recommended directions for use and allowed to set at 37°C under humid conditions for 10 minutes, lightly finished to create uniformsurfuces, ancl stored in distilled water °C for 24 hours prior to testing, under identical load and, strain-rate conditions as used for the CC&B cement, Similar to other published studies evaluating compressive strength of dental cements, six specimens per test group were prepared TABLET Ginn) reer Classification Ceramir C&B (CC&B) | Calcium aluminate/ | alass-ionomer | Full Plus (FP) Resin-modified glass-ionomer Tokyo, Japan Rely Luting Cement | Resin-modified | 3M ESPE XD glass-ionomer St. Paul, MN RelyX Unicem (RXU) | Self-adhesive resin | 3M ESPE AG cement ‘wwys.compendiumlive.com tence Ene eesical Doxa Dental AB Uppsala, Sweden GC Corporation D-82229 Seefeld, Germany | Information Concerning Cements Tested in Compressive-Strength Method Ereman ener P;1$8-01-708003 | Powder/liquid - hand L-ILA-01-0703001 | mix | osi2071 Capsule mixing/ delivery 20060306 Powder/liquid ~ hand 283748 Capsule mixing/ | delivery10 Foes Ow Desrat Reseancn ‘and tested in this compressive-strength protocol” Statistical analysis of the data was accomplished via calculation of the descriptive statisties (mean values and standard deviations) foreachexperimental group, and statistical significance of the meanvaluesof thedata, duesolely to the influence of themate- rials testod, was determined by aone-way ANOVA. with ranking of multiple mean values usingpair-wise multiple comparisons. Film thickness of the calcium aluminate /glass-ionomer ce- ‘ment was measured according to the test method described inthe International Standard test method (180 99174[2003}, Annex C).* The film thickness of the eement was recorded as the difference in thickness of the plates with and without the coment film, after a specified load of 150-N was applied asper this test method, The test was repeated fourtimes, and the average of the four tests was recorded, A Mitutoyo ABS micrometer (Mitutoyo America Corporation, wwvemitutoy®. com) was used to record the thickness of the plates with and without cement. AL-mm diameter eylinder was applied to the surface of the ‘mixed cement usinga400-gram indenterapplied forS-second intervals Settingtime was determined when the cement could no longer be penetrated. Thenetsetting time was recorded as thetime elapsed between theend ofmixingand thetime when thencede failed to make a complete circular indentation in the cement. Asperthe ISO test method, the test was repeated three times. Suneace HARONESS Surface hardness of the experimental CC&B wastested using a computerized dynamic indentation tester that controlled and recorded indentation depth and foree in real-time (CSM Instruments, www.esir-instruments.com). Cireular speci- mens that were 8 mm in diameter and 4 min thick of CC&B and a control cement—Fleck’s" Zine Phosphate cement (Mizzy, Keystone Dental, www:keystoneind.com)—were prepared. The cement specimens were prepared as per the ‘manufacturers’ instructions, and aftersetting for 10 minutes at 37°C (in 100% humidity), the surfaces of the samples were finished sequentially with 800 to 1200 silicon carbide paperon a table-top rotating polisher (Model 900, Electron Microscopy Seiences, www.clectronmicroscopyseiences. com) toa visual endpoint observed under amicroscopeat 50x magnification. CC&Band Fleck’s Zine Phosphate specimens, were incubated, respectively, in PBS and distilled water f hoursat’37°C. The specimens were tested in a CSM Dynamic Microhardness ‘Tester under conditions of 0.5 newton load, '80-second load, 10-second hold, and 30-second unload load ing cycle. A Poisson's ratio of 0.34 was used to calculate the microhardnessof the samples. Statistical analysisofthedata (n= 7) was accomplished via calculation of the descriptive statistics (mean values and standard deviations) for each, experimental group, and statistical significance of the data was determined by a one-way ANOVA. Jacket Crowni As per a modification of a technique reported by Leevailo] et al,’ the tooth preparation was a standard, 360-degree shoulder finish-line preparation, with uniform reduetion, Porcelain jacket erowns (PJCs) were cemented with CC&B (a= 10) or Euji Plus (n= 5) and stored in an incubator in, PBS at 37°C and examined over extended time periods @ years) for external cracks and/or eraze lines in the ceramic ‘material. Tooth types selected for this test included maxillary ineisors, cuspids, and premolars, Porcelain crown thickness reflected theanatomical contour ofthe teeth to replace tooth TABLE 2 een Cee eto ea Ceramir cae (cae) 159.71 + 26.78 Fuji Plus (FP) 138.21 £15.24 RelyX Luting Cement (RXL) | 96.34 #.9.79 RelyX Unicem (RXU) 18726 + 10.03 Mean Compressive Strengths of Cements Tested, Statistical Grouping, and Comparison to 1SO 9917-1 Minimum Compressive-Strength Values Statistical Pera Significance Grouping Compressive Strength’ ero) A Minimum 50 MPa i} A Minimum 50 MPa, | 8 Minimum 50 MPa I A Minimum 50 MPa | Noventbey/December 2023 + Volume $4 Spectal Issue 8TABLE 3 Average Values for Setting Time and Film Thickness for C&B Cement 48 £01min, Net setting time Film thickness: 168 40.89 structure removed by a standard porcelain jacket crown preparation. This test method servesas an indirect measure to access development of internal expansion stresses to induce possible vertical fractures due to cement expansion stress, Low-strength, feldspathic porcelain (Ceramco' I, DENTSPLY, wwwalentsply-com) was used as the ceramic material, Fach cemented crown was examined every 2 to 3 days for | month by a microscope under illumination with aan LED light at 10x magnification to assess for vertical or horizontal crack formation. At the end of 30 days, erowns were examined weekly for up to 52 weeks, Subsequently, periodic examinations were made over the following 2 years. Data were presentedas the number oferowns (out ofa total of 10 crowns for the experimental cement and five for the control cement) with evidence of cracks or fractures as a function of time off mersion, Results ‘The data and results of the compressive strength testing in thisstudy are listed in Table 2. One-way ANOVA indicated astatisticallysi cence in 24-hour compressivestrengths affected by'the type of ‘material tested (P<0.00)). Pair-wise statistical analysis of the data in Table 2 comparing CC&B to RelyX Luting Cement (@ RMGI cement) indicated statistically significant difference between the mean valuesof these groups (P< 0.001). However, pair-wise statistical analysis indicated no statistically signifi- ‘cant difference in 24-hour compressive strengths (P< 0.05) comparing CC&B to RelyX Unicem (@ self-etching, resin ‘cement; P= 0.838). Likewise, pair-wise statistical analysis of the above data indicated no statistically significant difference in 24-hour compressivestrengths (P< 0.05) comparing CC&D to Fuji Plus @RNGI cement; P= 0.118). Sertine Time As Assessment of setting time was conducted as per the ISO Standard 9917-1 (2003) for the determination of cement set tingtime. Acceptablesetting timewas determined by applying the acceptable range of setting times for a glass-ionomer cement, as described: minimum (glass-ionomer luting) = 1.5 swore compendtiamlive.com « Bosrox :: Gauwaarri = Hermanson icv 1. Porcelain jacet rons (Cs) cemented with Cra &8 cement. minutes; maximum (lass-ionomer luting) = 8.0 minutes. A seriesof three separate setting: time measurements was taken, for three separate mixes of the CC&'B cement. The data were asfollows:4 minutes, 45 seconds; 4 minutes,50seconds: and 4 minutes, 50 seconds, The average set determined to be 4.8 = 0.1 min, Fium Thickness ‘The assessment of film thickness for CC&B arrived at an overall average value of 164 (089) um. ‘The values for film thickness and setting timeare depicted in Tables. ‘Sunrace HARONESS ‘The Vickers hardness value for CC&B was 68.3 £ 17.2. The Vickers hardness value for the comparative cement, zine phosphate, was514+10.A statistically significantdifference between these values was established (P= 0.043). SEQUELAE OF EXDANSION—CEHENTATION OF PORCELAIN Jaciter Cr ‘There was no evidenee of any fractures occurting in any of the 10 porcelain jacket crowns cemented with CC&B over the 3-year observation period. The same was observed for the control cement, Fuji Plus; all five (5) poreelain crowns were intact. The cemented PJCs on the prepared extracted teeth are photographically represented in Figure 1. Discussion The results of the compressive-strength testing clearly demonstrate that both RMGI materials (Rely Luting Cement [RXI.] and Fuji Plus [FPD. the self-adhesive resin cement (RelyX Unicem [RXU), and the ealeium aluminate/ glass-ionomer cement (Ceramir C&B[CC&B)) all exceeded, the required strength level set by ISO Standard 9917-1. ‘CC&s performed acceptably and clearly met the Standards compressive-strength requirement, with a mean 24-hour compressive strength that exceeded the minimum required compressive strength under the Standard (G0 MPa) by more a12 PoctisOn Dewrat, Restart than a factor of 3. CC&Bs mean 24-hour compressive- strength value of approximately 160 MPa was eomparable tothe mean compressive strength of a well-established self adhesive resin cement, RelyX Unicem, ata mean comp! strength of approximately 157 MPa. CC&B was statistically strongerin its mean 24-hour compressive strength than one of the two RMGIstested in thisstudy, RelyX Lating Cement. It should be noted that the results of this study are compa- rable to values determined in other published studies of the mechanical-strength properties of luting cements, For example, the authors’ value for the compressive strength of Rely Luting Cement (lormerly Vitremer Luting Cement) of approximately 90 MPa to 100 MPa is similar to that of Piwowarezyk and Lauer” and Li and White." Kumbuloglu eL al” reported a mean compressive strength value of ap- proximately 145 MPa for RelyX Unicem Aplicap, which also compares very favorably to the value obtained in this study for that material. In the first published report of strength, properties of a calcium aluminate cement for dental use, Lod et al! reported mean compressive-strength values in a similar range to those documented in this report for the hybrid calcium aluminate/lass-Tonomer material ene aca SENSES The results found using the test method employed in this study to analyze potential expansion by this new cement over an observation period of up to 2 years indicated that CC&B did not produce, in a clinically modeled test method, potentially damaging expansion forces. Alternative test methods, such as flexural strength, have been recommended and used for strength testing for lut= ing cements, especially if thei composition contains resin components. This alternative test methodology is used in the ISO Standard 9917 ~ Part 2. The compressive strength. method used here was adopted due to the fact that the test cement being evaluated in this study, and most of the ce: ments recognized as bioactive or potentially bioactive, are ‘water-based. The literature, as documented in this paper's, cited references, also suggests that thiscompressive-strength, protocol has been and continues to be used for awide range ofcement chemistries for comparative purposes. Itis intuitively obvious to any cincian that film thicknessis critical parameter for any permanent dental luting cement. ‘The inclusion of atest for film thickness in the ISO Standard further amplifies this fact. Using the prescribed testing methodology of ISO 9917-1, the film thickness of CC&B was determined to meet the standard witha film thickness ofless than 25 jm. As per the 180 9917-1 requirement, aset of five measures were taken, which resulted inall five ilm thickness measures at or below 17 um, with an average value of 164 (0.89), a value well within the guidelines of the IS for luting cement film thickness. ‘While the viscosity of this cement was not measured, directly, the handling and consistency ofthe cement during seating of restorations suggests a viscosity bel tent with Newtonian flow properties with plastic flow characteristi ating of restoration: Setting time is defined as the period of time measured from ‘the end of mixing until the material has set according to the criteria and conditions specified in Annex A, International Standard, ISO 9917: Setting time is an important clinical property for a Inting cement. As per the Standard’s test ‘method, all of the setting times of the three cement mixes wore well within the net setting time standard (minimum, maximum setting times) of 2.5/8.0 minutes for zine phos- phate cement, and 1.5/6.0 minutes for glass polyalkenoate cements. The average value of these setting times was 4.8 = 0.1 minutes. CC&B met the setting time prescribed by the applicable International Standard. Surface hardness relates to the ability of a material to resist permanent deforma- standard wior cons lack of pseudo 's that could impede complete tion, usually measured in some form of an indentation model. Nevertheless, one for- mal text in the subject of dental materials" also suggests that “hardness is indication of .. resistance to in-service scratching.” Jastrzebski amplifies this property stating that: “The hardness of a material ean be measured b istance to seratching oF to indentation." Although a relationship between surfacehardnessand abrasion resistancein adental cement isnot directly proportional,it should be noted that in one investigation, such a relationship did in fact exist between the materials exhibiting the relative highest lowest valuesin terms of surface hardness and abrasion resistance fora group of glass-ionomer materials." In another study, which compared the toothbrush-dentifrice abrasion of RMGIs, there did appear to be a proportional relationship between abrasion resistance and surface hardness for the three RMGIs evaluated.” In fact, these authors concluded: “The lower abrasion resistance found in the tesit-modified products appears to be related to their lower surfave hard- ness,” ‘The comparative-reference material used in this test, zine phosphate cement, has a long and established successful clinical history asa dental luting cement, CC&B demonstrated amean Vickers hardness quite comparable to November/December 2012 + Volume 34 Special Lxsue 8that measured for zine phosphate cement, suggesting that this nw cement has a resistance to permanent deforma- tion—which may be a component in the process of surface scratching or application of certain abrasives—similar to that of the well established zine phosphate cement, Using a method described previously by Leevailoj et al” the cementation of PJC restorations to extracted teeth with, the experimental cement represents an alternative method to assess whether any luting cement produces changes and resultant lateral forces sulfi iatrogenic damage or cracks in weak full-coverage ceramic restorations. Those authors reported the ability to differ cntiate a potentially adverse effect among various types of mensional ‘ent to cause cements used in this speeifie cementation procedure. ‘The resullsof this approach applied in thisstudy using the ealeium aluminate /glass-ionomer cement clearly demonstrate an absence of any damage to these feldspathie porcelain-based crowns for up toa 2-year observation period, with the latter ‘material being one that has an inherently low tolerance to Lensile forces of a low magnitude, as would be generated by internal expansion or lateral “houp” stresse The PIC test was conducted, in part, as a result of prior reports suggesting that calcium aluminate cements may un dergo water sorptionand dimensional change levelssufficient to produce lateral tangential forces sufficient to damage or crack natural tooth structure. ‘The fact that this previously studied calcium aluminate cement lacked any polymerizable resin components, especially hydrophilic resin monomers that could act as swater-adsorbing hydrogels. made the mechanism for this hypothesized behavior unclear, Nevertheless, the results found usingthe test method employed in this study to analyze potential expansion by this new cement over an observation period of up to 2 years indicated that CC&B did not produce, in a clinically modeled test method, potentially damaging expansion forces. ‘The findings of this study suggest that a new ealeium aluminate /glass-lonomer cement possesses physical prop- erties comparable to other currently used luting cements. Still, one might inquire about how the physical properties and performance behavior of this particular bioactive dental cement compare to other bioactive cement chem- istries. The earliest of the bioactive cement formulations proposed for dental restorative purposes, the self-setting calcium phosphate cements, first appeared in the late 1980s." While highly biocompatible and displaying the ability to form hydroxyapatite under appropriate solu- tion conditions, the compressive strengths of these first bioactive cement formulas were low (compared to other dental cements) and on the order of 30 MPa to 40 MPa.” Another class of bioactive cements, the calcium silicates, areavailable commercially asa well known root-end filling pulp capping/‘root replacement material, mineral trioxide wowcompendiamlive.com Loor «: Pamewen = Bostox « G: HERMANSSON inAITHT aggregate (MTA). MTA has been shown to be bioaetive®* but its documented 24-hour compressive strength of 40 MPa positions it as initially weaker than other dental cements such as Super-EBA or IRM. ‘Two specific approaches to incorporate bioactivity Cie, apatite forming eapability) into glass-ionomer cements have ‘also been documented in the literature, One avenue has ‘been the incorporation of particles of bioactive glass into a glass-ionomer cement” ng propor tions of bioactive glass particles into the glass-ionomer reduced the cement’s compressive strength froma baseline mean level of 120 MPa to 100 MPa or less, Similarly, the surface hardness of these experimental cements was also reduced by these modilications, Another strategy explored with glass-ionomer cements—again, to improve their remineralization potential—has been the incorporation nfortunately, inerea of incremental amounts of a calcium-based remineral aasein plosphopeptide-amorphous calcium phosphate (CCP-ACP).* Itis interesting to note that the incorporation of 1.56% w/w CCP-ACP into the powder of commercially available glass-ionomer restorative (Fuji IX, GC Corporation) significantly inereased the compressive strength ofthis glass-ionomer material raising the compres sive strength of the control material from a mean of 138 MPa to 170 MPa. In reviewing the spectrum of bioactive or remineralizing cements that have been studied thus far and cited above, the strength characteristics ofthe ealeium aluminate (slass-ionomer cement presented in this paper appear encouraging and merit further exploration in the izing agent, realm of dental materials for restorative purposes. Conclusions As a result of this study; the authors conclude the following: ‘All cements tested demonstrated mean compressiv strength values in considerable excess of the ISO 9917-1 Standard minimum value oF50 MPa, » The calcium aluminate/glass-ionomer cement (CC&H) ignificantly higher compressive strength than ‘onc ofthe resin-modified glass-ionomer (RMGD cements (RXL) after 24 hours and a mean compressive strength comparable to the other RMGI (FP) and the self-adhesive resin cement (RXU). » The net setting time of the CC&B calcium aluminate lass-ionomer cement (4.8 m) Is within the requirement of 150 9917-1, >» ‘Thetilm thickness of the CC&B calcium aluminate/lass~ lonomer cement (168 jim) conformed to the ISO 9917-1 requirement of 25 um, » The CC&B calcium aluminate lass-ionomer cement does not appear to exert deleterious expansive pressure cffects of clinical consequence, based on laboratory tests ‘of porcelain jacket crowns showed s 18“ Focus Ox Dewea Resear » Within the limits of this study, Ceramir’ C&:B and the luting cements to which it was compared—RelyX Luting, RelyX Unicom, and Fuji Plus~all appear to meet the compressive- strength requirements described in ISO 9917-1 (2003) for a water-based dental luting cement. ‘Thisstudy was support npart by Doxa Dental AB, Uppsala, Sweden, Steven Jrerentes, DDS, PuD Professor; Department of Restorative Dentistry, Kornberg School of Dentistry, Temple University, Philadelphia, Pennsvlvanta Jesren Loov, PuD Director of Research, Doxa Dental AB, Uppsala, Sweden Conneiis H. Pariser, DMD, MScD, DSc, Pu Professor Emeritus, University of Connecticut, Farmington, Connecticut Dasit Bostox, DMD. Associate Professor and Chairman, Department of Restorative Dentistry, Kornberg School of Dentistry, Temple University Philadelphia, Pennsylvania Cony Gauri, DMD Resident, Oral and Maxillofacial S Center, Denver, Colorudo Laur Hrnvayssox, AB, PHD -gory: Denver Health Medical Chie Scientific Advisor, Founder, and Director, Doxa Dental AB, Uppsala, Sweden | Hondrum SO, Storage stability of dental litingeements.J Prosthet Dent. 1999:81(4) 464-408. 2, Attar N, Tam LE, McComb D. Mechanical and physical prop- ceties of comtemporary dental luting ayents. J Prosthet Dent 2003:80(2):127-134. 3, LOOE J, Svan F, Jarmar T, ctl. A comparative study of the bio- ity of three materials for dental applications. Dent Mater 2008:24(5):653-659. 4. International Ongantzation for Standardization, Dentistry Water based! cements—Part I: Powder Tiquid acid-base cements. Geneva, Switzerland; 2007, 180 9917-1:2003, 5. MitraSB, Kedrowski BL. Long-term mechanical propertiesof glass lonomers. Dent Mater. 199410(2):78-82, 6 Prentice LH, Tyas MJ, Burrow ME The eect of mixingtine on the handlingaand compressivestrength ofan encapsulated glass-lonomer ‘cement, Dent Mater. 2005:21(8):704-708. 7.YlieUrpoH, Lassila LV; NarhiT, Vallttu PK, Compressivestrength and surface characterization of glass fonomer cements modified by ss. Dent Mater. 2005;21(3):201-208, 8, International Organization for Standardization, Dentistry Water baseal cements-Part 1: Powder/Aiquid acid-base cements, Annex particles oPbioactiveg (C—Determination of film thickness (luting cements only). Geneva, Switzerland: 2007, 180 9917-1:2003. 9, LeevailojC.Platt JA, Cochran MA, Moore BK. 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