Literature Review
Journal of Veterinary Dentistry
A Review of Dental Cements
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
Dental cements provide a link or adhesive between a restora-
tion and prepared tooth, bonding them together through some
form of surface attachment. The cementing agent’s primary
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
a fixed prosthodontic restoration is to “lute” the restoration. It
derives from the Latin lutum, which means mud or clay. A
“luting agent” is the substance—such as cement, wax, or
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
adhesive properties, and thus, the terms “crown-cement” or
“crown cementation” are more appropriate.2
Dental cements are brittle materials when hardened, often
formed by mixing powder and liquid together. They are either
resin-based cements or acid–base cements. In the latter, the
powder is a basic metal oxide or silicate and the liquid is acidic.
An acid–base reaction occurs with the formation of a metal salt,
which acts as the cementing matrix. Dental cements are used
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
their use in veterinary dentistry.
The ideal cement has not yet been discovered; however, it
should meet the following criteria: (1) not harmful to the tooth
or surrounding tissues, (2) allows sufficient working time to
place the restoration, (3) be fluid enough to allow complete
seating of the restoration, (4) quickly forms a hard structural
layer strong enough to resist functional forces, and (5) does not
dissolve and maintains a sealed, intact restoration (Table 1).3
Properties of Dental Cements
Scientific studies of dental cements used in humans have eval-
uated the following categories: (1) biocompatibility, (2) caries
2018, Vol. 35(1) 18-27
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or plaque inhibition, (3) microleakage, (4) strength and other
mechanical properties, (5) solubility, (6) water adsorption, (7)
adhesion, (8) setting stresses, (9) wear resistance, (10) color
stability, (11) radiopacity, (12) film thickness or viscosity, and
(13) working and setting times.
Biocompatibility
An ideal dental cement should be biocompatible (ie, have little
interaction with body tissues and fluids), nontoxic, and have
low allergic potential.3
Caries or Plaque Inhibition
Caries are one of the primary causes of failure of cast restora-
tions in humans, which led to the popularity of the glass iono-
mer cements. This was due to the fluoride release associated
with these materials4 and the presumed benefit of reduced car-
ies. An ideal dental cement possesses antimicrobial properties
that reduce the effect of future plaque colonies at the restora-
tion margins. Caries have not been reported as a significant
cause of restoration failure in veterinary dentistry.
Microleakage
A restoration cemented with the ideal dental cement would be
resistant to microleakage. In humans, microleakage of organ-
isms around dental restorations has been implicated in adverse
pulpal response and reduced restoration longevity.5 Restoration
leakage is the most common cause of endodontic failure in
humans and can be a cause of failure in full crown metal
1
Arizona Veterinary Dental Specialists, Scottsdale, AZ, USA
Corresponding Author:
Kipp Wingo, Arizona Veterinary Dental Specialists, 1109 E. Falling Star Road,
Phoenix, Scottsdale, AZ 85086, USA.
Email: kippwingo1@icloud.com
Wingo
Table 1. The Ideal Properties of a Dental Cement.35
Property Ideal Material
Film thickness Low
Working time Long
Setting time Short
Compressive strength High
Elastic modulus Equal to dentin
Pulp irritation Low
Solubility Very low
Microleakage Very low
Removal of excess Easy
Retention High
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
Strength and Mechanical Properties
An ideal dental cement has sufficient mechanical properties to
resist functional forces over the lifetime of the restoration. In
addition, it resists degradation in the oral environment and
adheres to the underlying dentin. In order for a restoration to
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
predictor of clinical performance.12-16 Investigators have also
studied mechanical properties including flexural strength,
tensile strength, modulus of elasticity, fracture toughness,
hardness testing, creep, and effects of temperature.13,14,17-24
To determine flexural strength, a 3-point bending or flexural
test is performed. The flexural test defines the strength and
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
the middle. The flexural strength is calculated by the maximum
stress applied to material.
Diametral tensile strength is an indirect measure of tensile
strength. It is determined by forming the material to be tested into
a disk, then subjecting the disk to diametrical compressive forces
until fracture occurs. The tensile strength can then be calculated
mathematically. This test is referred to as the Brazilian method
and is favored because is it relatively simple and reproducible.26
An elastic modulus, or modulus of elasticity, is a number
that measures an object or substance’s resistance to being
deformed elastically (ie, nonpermanently) when a force is
applied to it. In its simplest definition, it is the “stiffness” of
a substance. The ideal elastic modulus of a dental cement is
thought to be equal to that of dentin.1 A dental cement with a
close elastic modulus to that of dentin provides for less stress
concentration at the cement–tooth interface which results in a
more durable bond. Resin composites with hybrid filler have an
elastic modulus very near that of dentin.27
Fracture toughness is a property that describes the ability of
a material containing a crack to resist fracture.28 The hardness
19
of a material is determined by making a symmetrical-shaped
indentation with an indenter that has a standardized force or
weight. The hardness can be calculated from the dimensions of
the indentation produced. Examples of hardness values for
enamel, dentin, cementum, and cobalt–chromium partial den-
ture alloy are 343, 68, 40, and 391 kg/mm2, respectively.29
An increased incidence of failures can be a consequence of a
material that exhibits high creep. Creep is a time-dependent
and gradual deformational change that can occur under cyclical
loads such as chewing.
Changes in temperature may adversely affect some dental
cements. This is clinically significant because testing dental
cements at room temperature may provide different results
compared to testing at body temperature.
Solubility
An ideal dental cement is resistant to disintegration and dis-
solution when the cement is submerged in water or other solu-
tions over the lifetime of the restoration. Increased solubility
will affect marginal integrity of a restoration leading to
increased plaque accumulation. Zinc phosphate and polycar-
boxylate are examples of dental cements with a high solubility.
Resin-based cements have a very low solubility.30
Water Adsorption
Water adsorption refers to adhesion of water molecules to a
surface, whereas absorption refers to uptake of water by the
entire volume of a structure. Adsorption can adversely affect
the physical and mechanical properties of the dental cement31,32;
however, the resultant expansion may be beneficial, as it coun-
teracts polymerization shrinkage.33
Adhesion
The term adhesion refers to the establishment of molecular
interactions between a substrate and an adhesive brought into
close contact, creating an adhesive joint.34 When using tradi-
tional luting agents or nonadhesive dental cements, such as zinc
phosphate, retention is dependent on the geometric form of the
tooth preparation. That limits the paths of displacement of the
cast restoration35; therefore, some human prosthodontist may
use nonadhesive dental cements such as zinc phosphate. In
veterinary dentistry, compared to human dentistry, a suitable
geometric form can rarely, if ever, be obtained. Therefore, most
veterinary dentists use adhesive cements for fixed restorations.
In human prosthodontics, mechanical interlocking with
rough surfaces on a parallel tooth wall preparation is frequently
the primary means of retention for dental cements regardless of
chemical composition.36 Mechanisms of cementation have
been described as nonadhesive, micromechanical, and molecu-
lar adhesion.37 Dental cements that are considered nonadhesive
bonding agents (eg, zinc phosphate) fill the restoration/tooth
gap, thereby holding by engaging in small surface irregulari-
ties. All cements do this to varying degrees; thus, success of
20
nonadhesive dental cements is primarily dependent upon the
geometric form of the tooth preparation.35 In contrast, with
micromechanical bonding, the surface irregularities are
enhanced through air abrasion (sand blasting) of the restora-
tion. Pumice polishing and/or acid etching of the tooth can
provide larger defects for the cement to fill with a high tensile
strength material. Resins and resin-modified glass ionomers
(RMGIs) are examples of dental cements that micromechani-
cally bond. Molecular adhesion consists of van der Waals
forces and weak chemical bond formation between the dental
cement and the tooth structure. Two examples of dental
cements exhibiting molecular adhesion are polycarboxylate
and glass ionomer.1
Setting Stresses
Some dental cements shrink during setting, which causes unde-
sirable stresses in the set material, and can cause contraction
gaps in the dentin–cement interface. To some extent, these
stresses can be compensated for by expansion due to water
sorption in some dental cements.38
Wear Resistance
Dental cement wear is seldom a problem with full-coverage metal
prosthetics in veterinary medicine. Wear is a concern in human
dentistry with the use of inlays, particularly with increased
restoration–tooth gap widths.39 Dental cements used to fix crowns
have been tested in vitro for wear, and wear performance is not
well correlated with mechanical properties data.40
Radiopacity
In human prosthodontics, an ideal dental cement should be
radiopaque to enable the practitioner to distinguish between a
cement line and recurrent caries; therefore, it is important that
dental cements have greater radiopacity than dentin. One study
of 435 dogs reported a 5.3% incidence of caries41; however,
there have been no studies performed to determine the preva-
lence of caries associated with full veneer crowns in dogs. The
use of full crown restorations made from metal renders the
radiopacity of the dental cement moot. This is also true for
color stability of the dental cement.
Film Thickness
The film thickness or viscosity of the dental cement can
directly affect long-term clinical success. Generally, dental
cements should exhibit low film thickness. Low film thickness
improves the seating of the crown and decreases marginal dis-
crepancies, thereby reducing plaque accumulation, periodontal
disease, cement dissolution, and caries (humans).42 Resin-
based adhesives typically have a higher film thickness;
however, resin cements are less soluble in oral fluids that com-
pensate.43 As the film thickness increases, the tensile bond
strength of cements to cast alloy crowns decreases.44 Increased
incidence of tilted crowns has been associated with resin-based
Journal of Veterinary Dentistry 35(1)
dental cements when compared to zinc phosphate, glass
ionomer, or polycarboxylate cements.45 This is most likely due
to the high viscosity of the resin. Manipulating variables, such as
the ratios of components and mixing temperature, can influence
film thickness. Cold mixing can significantly reduce the film
thickness of glass ionomers and increase achievable powder–
liquid ratios.46 Alternatively, dual-cure resin cements exhibit
larger film thicknesses when they are mixed at lower tempera-
tures.47 Generally, glass ionomer has the lowest film thickness
followed by polycarboxylate, RMGI, zinc phosphate, and resin-
based cements.48 All these cements fall within the American
Dental Association’s specifications for cements and are within
the range of clinical acceptability for a marginal gap.49,50
Working and Setting Times
Generally, a long working time and a short setting time are
desired. Enough time is needed to properly seat the restoration
without the dental material setting prior to placing it onto the
tooth. Conversely, after the restoration is seated, it is desirable
for the dental cement to set as fast as possible. Working times
can be affected by several factors such as temperature, altera-
tions in powder–liquid ratios, and over- or undermixing. The
working times of glass ionomer and resin cements are
decreased as temperature increases.51 Utilization of a frozen
slab technique (18 C to 24 C) will extend the working time
of zinc phosphate cement. However, the slab temperature most
often used is þ4 C and þ8 C (refrigerator temperature) due to
the achievement of maximum compressive strength.52 The use
of a chilled slab will significantly extend the working time of
glass ionomer cements.53 Too much powder will reduce the
working time of glass ionomers. The working times of resin-
based cements are not significantly reduced by variations in the
mass ratio of base and catalysts, up to 20%.54 With dual-cure
composite resin cements, working times are significantly
reduced by the use of a dual-cure adhesive.55 The typical
mixing time of glass ionomers is 10 seconds at 3000 cycles per
minute using a triturator; either too long or too short of a
mixing cycle can adversely affect working time.56
Ease of Use
The ability to completely remove excess dental cement after
cementation can be a concern. In human dentistry, rapid-onset
complications associated with excess cement left around
crowns have been documented.57 The removal of bulk cement
can be very difficult to accomplish without damaging the sur-
rounding tissues, which would expose the early cement margin
to blood and saliva. Excess tissue-damaging cement can reduce
the bond strength and accelerate erosion.58,59 Removal of the
overabundance of cement that must occur right after the initial
set may unfortunately pull unset cement from under the restora-
tion margin. Generally, zinc phosphate is the easiest to remove,
and resin-based cements are the most difficult. The ideal dental
cement will reach an intermediate stage during setting when it
is possible to easily “peel away” the excess cement in one or
Wingo
Table 2. The Basic Composition of Dental Cements.
ZOE Zinc oxide þ eugenol + EBA
Zinc phosphate Zinc oxide þ magnesium oxide þ phosphoric
acid þ water þ buffers
Polycarboxylate Zinc oxide þ polyacrylic acid
Glass ionomer Polycarboxylate þ fluoroaluminosilicate glass þ
water þ tartaric acid
RMGI Glass ionomer þ resin
Compomer Glass ionomer þ Composite (resin þ glass filler)
Resin-based Resin þ filler (glass or silica)
cements
Abbreviations: EBA, ethoxybenzoic acid; RMGI, resin-modified glass ionomer.
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.
Water-Based Cements
Zinc phosphate, polycarboxylate, glass ionomer, zinc oxide
eugenol (ZOE), and ethoxybenzoic acid (EBA)-reinforced
ZOE cements are water-based cements that have traditionally
been the mainstays for cementing indirect restorations
(Table 2). All water-based cements have increased solubility,4
lower strength,60 greater microleakage,61,62 and lower bond
strength63,64 than the resin-based cements. Zinc oxide none-
ugenol and ZOE are good temporary cements. Polycarboxy-
late is more durable and bonds to teeth but has significant
solubility. Zinc phosphate, long the mainstay of cementation,
has high solubility but has a higher retention rate than poly-
carboxylate, yet it does not actually bond to teeth. Glass iono-
mer and polycarboxylate were designed to bond to tooth
structure and to improve cement properties. Glass ionomer
cements bond to teeth and are lower in solubility and have a
higher retention rate than zinc phosphate.
Zinc Oxide
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-
tible because of their neutral pH, minimal interaction with
tissues and fluids, and are relatively nontoxic when compared
to RMGIs and resin cements.34
The reaction between zinc oxide and eugenol has several
applications in dentistry such as endodontic sealers and root-
end filling materials, periodontal coating, inelastic impression
materials, cavity base, and temporary restorations in human
dentistry.34 In the mid-1970s, reinforced ZOE cements and
cements containing EBA were developed. These cements have
considerably better mechanical properties and are therefore
used as definitive fixing cements in selected cases in human
prosthodontics.65 Due to the lower bond strength and rare use
of temporary restorations, zinc oxide cements are seldom used
in veterinary dentistry for full-coverage prosthodontics crowns.
21
Zinc Phosphate
Zinc phosphate has the longest track record of use in dentistry.
It was introduced in the 1800s and is the oldest dental cement.1
For many decades, it was the “gold standard” for permanent
dental cementing agents and showed a success rate of up to
98%.66 It is the cement other cements have been measured
against. It is still commonly used in human dentistry for per-
manent and often temporary dental cements; however, resin-
based cements are more convenient and have been shown to
provide a greater retentive force compared to zinc phos-
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.
Polycarboxylate
In 1968, zinc polyacrylate (polycarboxylate) cements were
introduced, the first dental cement that adheres to tooth
structures.70 The goal was to develop a dental cement that
combined the strength of zinc phosphate cements with the
adhesiveness and biocompatibility of ZOE cements.71 The
zinc oxide and the polyacrylic acid react to form a zinc poly-
acrylate that surrounds the partially reacted zinc oxide powder
particles.72
In human dentistry, zinc polycarboxylate cements are water-
based cements used as final cements for retention of crowns
and bridges.72 Polycarboxylate cements are not as strong as
zinc phosphate cements but are less irritating to the pulp.41 In
general, the compressive strength for polycarboxylate is
approximately one-half to two-thirds that of zinc phosphate,
and the tensile strength is one-third more than that of zinc
phosphate.73 The modulus of elasticity (stiffness) has one-
third of the range of zinc phosphate, therefore providing a
material that can display significant plastic deformation upon
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
the cement.74
Glass Ionomer
Glass ionomer was first introduced in 1969 and was originally
known as aluminosilicate polyacrylic acid.1 Glass ionomer
combined the technologies and chemistry of silicate and zinc
polycarboxylate materials to incorporate the desirable charac-
teristics of both.75 “Glass polyalkenoate cement” is the official
name used by the International Standards Organization; the
term “glass ionomer” is considered generic and covers a larger
group of cements with similar compositions.74 Glass ionomers
contain finely ground glass filler and fluoroaluminosilicate
(FAS), which avoids the susceptibility to dissolution by sub-
stituting phosphoric acid with the polymeric carboxylic acids
of zinc polycarboxylate materials.75 Original glass ionomer
systems have undergone several changes, but all conventional
glass ionomers have the following components:75
22
 polycarboxylic acid
 FAS glass
 water, and
 tartaric acid
Tartaric acid is added to increase the working time and
improves the setting reaction of the cement.75,76 Tartaric acid
acts as an accelerator that aids in the extraction of ions from
aluminosilicate glass and facilitates their binding to polyanion
chains. Postsetting hardening is significantly increased.77
The original use of glass ionomers was as restorative mate-
rials for anterior teeth in humans. They exhibit molecular
adhesion to dental hard tissues and release fluoride for a rel-
atively longer period. Molecular adhesion to tooth structure is
achieved by chelation with calcium and phosphate ions in
dentin and enamel. Glass ionomers are also used as dental
cements. Water balance of the newly placed cement is impor-
tant, as the cement contains water and releases water during
the setting process. During the first several minutes, the
cement can be contaminated by saliva causing loss of cement
by erosion due to early solubility.1 It is generally recom-
mended to temporarily protect the glass ionomer cement with
a varnish after bulk removal because portions of the ions are
still in a soluble form while the matrix is forming.74 It has been
demonstrated that leaving excess glass ionomer undisturbed
for 10 minutes prevented any significant erosion in a wet field.
Conversely, keeping the exposed cement dry too long
increased the potential for dehydration and microcracking.78
The application of petroleum jelly to the exposed cement mar-
gin has been suggested as a simple solution to maintain water
balance.79 The new glass ionomer cements are fast setting and
have a higher resistance to water within 5 minutes; therefore, it
is unnecessary to use a waterproof varnish or resin sealer to
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
compressive strength and crown retention results of glass
ionomers are higher than zinc phosphate. Microleakage
studies give variable comparisons, and antibacterial proper-
ties are considered slightly better than zinc phosphate.4 Glass
ionomer cements have a low flexural strength but a high mod-
ulus of elasticity and are therefore very brittle and prone to
bulk fracture.81 The strength properties of glass ionomer
cements are much inferior to those of resin cements and
therefore should not be used in restorations that are high
stress locations. 81,82 Shelf life may be an issue because
viscosity has been shown to increase after 24 months.83
Resin-Modified Glass Ionomer
In the 1980s, with the desire to improve resistance to fracture
and dissolution, water-soluble polymers (or polymerizable
resins) were added to conventional glass ionomers to create a
new category of dental cements called RMGIs.58,80 They are
also known as “hybrid ionomers.” In the original RMGI, part of
the water component of glass polyalkenoate cement was
Journal of Veterinary Dentistry 35(1)
replaced with a water–hydroxymethyl methacrylate mixture
plus an initiator/activator for the added resin. Newer systems
are more complex and include other dimethacrylates such as
ethylene glycol dimethacrylate, glycidylmethacrylate, and
Bis-GMA, as well as various chemicals to initiate and control
the resin polymerization.74 The RMGIs use an electrostatic
interaction of polycarboxylate acid with hydroxyapatite of the
tooth to bond to dentin and enamel. The RMGIs form ionic
bonds with hydroxyapatite around the collagen in the dentin
together with the micromechanical interlocking of the RMGI
that hybridizes the dentin.84 The resin component provides a
micromechanical interlock to dentin and enamel. The hybri-
dization with dentin creates greater bond strength compared
to conventional glass ionomers and results in higher fracture
resistance compared to glass ionomers but less than standard
resin-based cements.85-87
The bond strength of RMGI to various indirect materials has
been tested and has been found to fall between conventional
glass ionomer and resin-based cements for sandblasted Ni-Cr
alloys. 88 The RMGI has approximately double the bond
strength to sandblasted, high-noble metal alloys when com-
pared to conventional glass ionomers and zinc phosphate, but
resin-based cements have 6 to 10 times higher bond strength
than RMGI.63
The mechanical properties of RMGI fall behind those of the
self-adhesive resin-based and conventional resin-based
cements.89,90 The RMGI is less susceptible to early erosion
during setting, less soluble, and has higher compressive and
tensile strengths than unmodified glass ionomer dental
cements. Film thickness and adhesion to tooth structure are
similar.91 They also release fluoride, which enhances cario-
static potential, but the amount varies by product.4 Excess
RMGI can be difficult to remove due to the presence of resin.
Compomers
The addition of resins to conventional glass ionomers led to the
evolution of a new and diverse group of potential dental-
cementing materials, which now represent a broad spectrum
of products ranging from conventional glass ionomer to com-
posite resin. A composite resin is resin mixed with a filler
material. The filler in composites used for the creation of com-
pomers is glass. Compomers, also known as polyacid-modified
composite resins, appeared in the late 1990s 92 and were
described as being a combination of composite resin (comp)
and glass ionomer (omer), offering the advantages of both.80
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-
ical behavior of compomers is more like that of composite
resins than of glass ionomers, with higher compressive and
flexural strengths than RMGI but inferior strength to unmodi-
fied composite cements.92 Little, if any, tooth adhesion occurs
without a resin-bonding agent, and fluoride release is very
limited.80 Cleanup of excessive compomer can be challenging
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
Methyl methacrylate-based resin cements have been available
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
weight of glass or silica).91 Additionally, the distribution of the
filler and initiator content has been altered to allow for a lower
film thickness and suitable working and setting times.94
The major constituents of resin-based cements are dimetha-
crylate resin and glass filler and often proprietary enhance-
ments. 95 Resins bond to enamel by micromechanical
interlocking into an acid-etched surface. Bonding to dentin is
also micromechanical but is more complex, often requiring
multiple steps that include removal of the smear layer and
surface demineralization. This is followed by application of
an unfilled resin-bonding agent or primer to which the resin
chemically bonds.1 Resin-based cements reduce microleakage
and have remarkably low solubility, improved strength, and
improved retention compared to water-based cements.96 The
compressive and tensile strengths, toughness, and resilience of
resin cements equal or exceed those of other dental cements.1
Conversely, most resin-based cements offer no fluoride
release or uptake, and film thickness may be relatively high.1
Resin-based cements can be self-cured, light cured, and dual
cured. They are the strongest, least soluble, best bonding
cements. They also are more technique sensitive and expensive
than most other materials used for cementation,91,97-104 costing
up to 175 times that of zinc phosphate.83 Removal of excess
resin-based cement can be difficult.
Self-Adhesive Resin-Based Cements
Resin-based cements have long been valued because of their
high retentive strength, resistance to wear, and low solubi-
lity.105 However, one of the common dissuading factors regard-
ing their use is the need of multiple steps (etching, drying,
priming) for bonding. Self-adhesive resin-based cements are
defined as cements based on filled polymers designed to adhere
to tooth structure without the necessity of separate etching,
drying, and priming. The first commercial product was RelyX
Unicem,a which was introduced to dentistry in 2002. Self-
adhesive resins have gained rapid popularity with more than
a dozen commercial brands now available.106 Self-adhesive
resin-based cements were developed to provide a dental cement
with a simple application procedure, combining the advantages
of glass ionomers (adhesion, fluoride release) with mechanical
properties comparable to those of resin-based cements.107 To
eliminate the need for etching, priming, and bonding, this mate-
rial was formulated with phosphoric acid–modified methacry-
late monomers, which enable the cement to self-adhere to the
tooth surface. At the same time, the monomers create a cross-
linked cement matrix during radical polymerization, which
contributes to greater mechanical and dimensional stability.108
24
Table 4. Ranking of Cement Types Based on Durability, Strength, and
Cost.14
Durability and Strength Cost
Lowest Lowest
Zinc oxide noneugenol
Zinc oxide eugenol
Polycarboxylate
Zinc phosphate
Glass ionomer
RMGI
Self-adhesive resin based
Resin based
Highest Highest
Abbreviation: RMGI, resin-modified glass ionomer.
These cements undergo a unique change from acidic to
neutral from initial mixing to 24 hours after application, which
enables them to adhere to tooth structure and also maintain
long-term strength. Many brands of self-adhesive resin-based
cements have a pH of approximately 2.0 immediately after
mixing, which is important in its self-adhesion and also enables
a high moisture tolerance. This low pH level and accompany-
ing hydrophilicity allow the material to adapt well to the tooth
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
makes it resistant to water uptake, helping prevent staining and
cracking and adding to its long-term stability.108
Self-adhesive resin-based cements that self-etch do not
remove the smear layer, whereas the 3-step and 2-step bonding
systems provide smear layer removal.109 Use of a separate etch-
ing and bonding step significantly improves the bonding strength
of self-adhesive cements.110-113 Ultimately, resin-based cements
produce higher long-term tensile bond strengths than self-
adhesive resin-based cements.114-116 Self-adhesive resin-based
cements can be self-cured, light cured, or dual cured.
Conclusion
Considering the various strength values, solubility, modulus
of elasticity, susceptibility to wear, microleakage, pulpal irri-
tation, and durability, the various classes of cements can be
ranked by their durability and suspected longevity in clinical
situations.97,117,118 Water-based cements are weaker and less
durable. Zinc oxide noneugenol and ZOE cements are good
temporary cements. However, this application is rarely
needed in veterinary dentistry. Polycarboxylate is more dur-
able and bonds to teeth but has significant solubility. Zinc
phosphate cement, long the gold standard of cementation, also
has solubility issues but is stronger than polycarboxylate.
Glass ionomer cements bond to teeth and are lower in solu-
bility and stronger than zinc phosphate. Resin-modified glass
ionomer cements have even less solubility and better strength
than conventional glass ionomer cements and also a stronger
bond to teeth. The self-adhesive resin-based cements have
Journal of Veterinary Dentistry 35(1)
improved strength properties, lower solubility, and greater
bond strength than the RMGI. Resin-based cements are the
strongest, least soluble, best bonding cements of any of the other
choices. They are also more technique sensitive and more
expensive.91,99,100,102-104,115,116 All cements with dual-cure
capability, both conventional resin and self-adhesive resin, show
significantly superior properties when light cured.116,119-122
Quality veterinary dentistry, in part, includes the use of
prosthodontics, which will require the use of dental cements.
The author’s practice has observed an 80% increase in the
frequency of prosthodontic applications over a 10-year
period. It is therefore important for the veterinary dental prac-
titioner to understand the basics of dental cements. Consider-
ing all variables associated with successful cementation,
resin-based cements consistently yield the best results. While
resin-based cements may significantly improve tensile
strength when related to retention form, occlusal interference,
and patient stresses, this beneficial property should never
serve as a substitute for meticulous technique in their appli-
cation or in tooth preparation. There is no doubt that new and
improved dental cements will become available for use in
veterinary patients. It has been said that the wise dentist is
never the first to use a new material or the last to use an old
material (Tables 3 and 4).123
Materials
a. 3M ESPE, St Paul, Minnesota.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to
the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, author-
ship, and/or publication of this article.
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