Current Trends for Cementation in Prosthodontics: Part 1-The Substrate

Abstract

With the vast possibilities of restorative dentistry nowadays and the constant development and release of restorative materials with improved mechanical and esthetical properties, there is a growing body of research on adhesive systems and cementation materials, as well as the adequate choices thereof in everyday clinical practice. There are high demands from the dental cements with regard to their adhesion to various substrates and restorative materials, their mechanical properties, resistance to dissolution in the oral environment, esthetic considerations, etc. A material that meets all these requirements is not yet available, and each available material presents certain shortcomings. However, thanks to the advancements in dental material research, polymers-based cements have gained admirable mechanical and esthetic properties, as well as versatility. With the plethora of products available on the market, clinicians are often faced with difficulties in the choice of a material adequate for certain clinical situations. Indeed, important factors to consider are the substrate for cementation and the restoration material. The aim of this review was to provide clear and literature-based clinical recommendations for the adequate cementation of prosthodontic restorations with regard to the cementation substrate. Considering that there is no gold standard protocol applicable in all clinical cases, since the properties of the cementation abutment could substantially differ, important individual considerations must be made for each situation.

Keywords: abutment; cementation; composite resin; dentin; enamel; luting; substrate.

Figure 1

List of resin cements currently available on the market classified by modality of application and polymerization. * Cement contains MDP (10-methacryloyloxydecyl dihydrogen phosphate).

Figure 2

SEM micrograph of enamel surface etched with 37% phosphoric acid gel for 30 s. The prism core material and the interprism areas can be observed. Original magnification of 1200×.

Figure 3

SEM micrograph of dentin surface etched with 37% phosphoric acid gel for 15 s. Original magnification of 12,000×. (a) Superficial dentin with wider peritubular areas and fewer dentinal tubules. (b) Deep dentin with a higher number of dentin tubules and reduced areas of peritubular dentin.

Figure 4

Representative SEM image of primary carious dentin. High degree of dentin demineralization with exposed collagen fibers and bacteria-infected dentin can be noted. Original magnification of 2500×.

Figure 5

Reinforced immediate dentin sealing on teeth prepared for indirect partial restorations. (a) Teeth immediately after the preparation; (b) teeth immediately after the application of reinforced IDS under rubber dam isolation; (c) teeth after the application of reinforced IDS after the removal of rubber dam.

Figure 6

Tooth abutments restored with different restorative materials prepared for complete crowns: (a) the abutments after the preparation; (b) abutments after air-particle abrasion.