Dentaltown August 2018 - 81
resin cements. Unfortunately, this results in many debonded
restorations. There was also confusion surrounding which
cement and procedures should be used.
As reported by Marshall D. Fagan,3 every time the
clinician places a final restoration, there are three key
considerations to start with:
1. The type of restoration (crown, onlay, veneer, etc.)
2. The material (lithium disilicate, zirconium, metal, etc.)
3. The tooth preparation design.
The following are the current guidelines for zirconium
restorations as outlined by Dr. Gordon Christensen:4
* Use resin-modified glass ionomer (RMGI) cement for
zirconium restorations when the tooth preparation has
near-optimum characteristics. Optimum characteristics
are at least 4mm in height from the gingival margin to the
occlusal table and the lack of parallelism of the preparation
walls should be up to, but not more than, 20 degrees from
the long axis of the tooth being prepared.
* If the tooth preparation does not have the optimum
characteristics, a self-adhesive resin cement (bonding
materials incorporated in the cement) or adhesive cement
(bonding material placed on the tooth preparation before
cementation) is recommended. Avoid contact of phosphoric
acid with zirconium restorations. Because of the absence of
a glass phase, acid etching is not effective with zirconium
materials.5,6
Since its introduction in 1972,7 glass ionomer cements have
been viable dental materials. When the two components (glass
and acid) were mixed, these materials self-cured. Twenty years
later, "resin modified" denotes the addition of resin groups to the
glass ionomer material.8 These light-cured RMGI cements offered
many benefits and were followed by the self-cured luting cements,
providing a continuous improvement over the years.
The physical properties of RMGI cements make them ideal
for cementing zirconium restorations. They provide a continuous
fluoride release, hydrophilicity that allows for use in hard-to-reach
places with limited to no isolation, and can bond directly to dentin,
minimizing postoperative sensitivity. RMGI cements also create a
chemical seal that minimizes microleakage, have an excellent film
thickness and allow for quick and easy placement and easy cleanup.
With continuous clinical studies and research, the following
are the guidelines the CR Foundation recommends for cementing
zirconia restorations:
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81
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