Joshua Austin, DDS, MAGD
1. Which resin cements are you regularly using in your practice?
I routinely use Panavia V5 (Kuraray Dental), Multilink Automix (Ivoclar Vivadent), RelyX Ultimate (3M Oral Care), and Ceramir (Doxa Dental). There are plenty of great self-etch resin cements on the market. Choosing the right type of cement for the situation and your treatment of the inside of the crown before cementation are far more important than any brand name.
2. What clinical situations determine when you use one resin cement over another?
There are two pieces of information I need when deciding which cement I want to use. The first comes from the prep itself. The second is the type of crown material. If the walls of the prep are 3 mm or longer and the prep is somewhat retentive (meaning it has less than 15 degrees of taper), anything you use will probably work well. A resin-modified glass ionomer luting cement is a great choice in these situations because of the ease of luting and the easy cleanup. If I have a prep wall that is shorter than 3 mm or a more advanced taper, I look to a self-etch resin cement. Panavia V5, Multilink Automix, and RelyX Ultimate are great choices.
When using a resin cement, I have much more success with the self-etch variety than I do with the self-adhesive ones. A self-adhesive resin cement is one in which all the chemistry is in the cement syringe. No primer is needed first. These cements have not performed as well clinically as intended. I personally do not use this class of cements in my practice. Self-etch cements, which require a primer to be applied to the prep first, perform much better.
A sometimes overlooked aspect of cementation is the treatment of the intaglio of the crown. A zirconia crown should be air abraded with 50-micron aluminum oxide, followed by a 20-second scrub of Ivoclean (Ivoclar Vivadent) and an application of a primer such as Monobond Plus (Ivoclar Vivadent) or Clearfil Ceramic Primer (Kuraray Dental). Lithium disilicate crowns should not be air abraded, especially with aluminum oxide. The intaglio should be cleaned with a scrub of Ivoclean or phosphoric acid etchant, followed by application of a silane product. Monobond Plus works great for this as well.
The key things to remember are that you should never put a phosphoric acid etchant on the inside of a zirconia crown, and you should never air abrade the intaglio of a lithium disilicate crown. If you are aware of your preparation and treat the inside of your crown appropriately, you should have few issues.
Lance Timmerman, DMD, MAGD
1. Which resin cements are you regularly using in your practice?
RelyX Unicem (3M Oral Care), RelyX Veneer (3M Oral Care), and Ceramir are my go-to products.
2. What clinical situations determine when you use one resin cement over another?
If I am bonding veneers, I want a light-cure-only material with as much bond strength as possible. In the posterior, with limited light and likely deep margins, where light curing would be unpredictable, I want something dual cure.
Howard S. Glazer, DDS, FAGD
1. Which resin cements are you regularly using in your practice?
All of the following: Ceramir, Activa Bioactive Cement (Pulpdent), SpeedCem Plus (Ivoclar Vivadent), Zero-G Bio Implant Cement (Taub Products), G-Cem LinkAce (GC America), and Envy (Essential Dental Systems).
2. What clinical situations determine when you use one resin cement over another?
Two main factors can influence the choice of cement: the size and shape of the remaining prepared tooth structure and the material used for the restoration. The other thing to consider is whether to use a primer. Since I like to use self-etch and self-adhesive cements, I often follow this rule: if the prep is retentive, then you do not need a primer; if it is not retentive, then a primer is necessary. The primer I generally use is Z Prime Plus (Bisco Dental).
I still do a lot of porcelain-fused-to-metal (gold) crowns, and as such, I rely on cements such as G-Cem LinkAce, Ceramir, and Envy. If I am redoing a crown, and if it is the first or second time the patient has had this crown done, and if I think the prep is close to where the pulp may be, I opt for Activa Bioactive Cement. When it comes to zirconia crowns, I generally opt for SpeedCem Plus because it is automix, easy to use, and highly radiopaque. Although I seem to have returned to using more screw-retained implant crowns, I do still have a need to cement crowns to abutments, and for that I am using Zero-G Bio Implant Cement.
There are two more important factors to consider in one’s cementation protocol: preparation of the internal surface of the restoration and cleaning of the crown(s) prior to cementation. To handle the first issue, and prior to final cementation, I make sure the inner aspect of the crown is microetched (50-micron particle size). For this, I use the EtchMaster (Groman Dental). As for cleaning the crown after trying it in, I first apply GoCHx Gel (Taub Products), and then I use either Ivoclean or, if it is a zirconia crown, ZirClean (Bisco Dental).
