What is the Best Available Luting Agent for Implant Prosthesis?

Cement-retention is a viable option in restoring dental implants. A wide range of dental cements with different properties are commercially available for use in the cementation of implant prostheses. The selection of a dental cement for proper clinical application can be challenging. This article overviews the commercially available dental cements used in cement-retained implant-supported prostheses. Guidelines for cement selection are presented according to abutment and prosthetic material. Cementation techniques to reduce excess cement in peri-implant tissues are also mentioned.

Key points

  • A wide variety of dental cements are commercially available to retain an implant-supported prosthesis. Each cement material has certain characteristics and properties.

  • Retention of dental cements for implant-supported prosthesis varies from tooth-supported prosthesis. Retention and esthetics are the main factors in cement selection guideline.

  • Peri-implant mucositis and peri-implantitis are major concerns when considering cement-retained implant prosthesis. It is customary to use different cementation techniques to minimize excess cement.


Cement-retained implant-supported prostheses (CRISP) have been commonly used because of simplicity and cost effectiveness. Peri-implant health parameters were reported to be similar around screw-retained and cement-retained prosthesis, provided that excess cement is removed. Although the fabrication of cement-retained prostheses is simple and similar to tooth-borne prostheses, the retention of dental cements varies between CRISP and tooth-supported prostheses. A survey by Tarica and colleagues (2010) showed that resin-modified glass ionomer (GI) is the most preferred cement for CRISP in United States dental schools. The second most popular cement is zinc oxide eugenol (ZOE), followed closely by GI. Polycarboxylate (PCB) and acrylic urethane were the least used materials. This article will shed light on the characteristics of dental cements used in implant dentistry. It also provides selection criteria according to the material of the abutment and prosthesis.

Characteristics of an ideal cement

An ideal cement should have the following characteristics:

  • Biocompatibility

  • Adequate mechanical characteristics

  • Promotion of tissue health

  • Adequate marginal seal

  • Dissolution resistance

  • Radiopacity

  • Excellent esthetics

  • Cost effectiveness

An ideal cement is yet to be developed. The clinicians’ preference and clinical situation are the currently used selection criteria.

Dental cement materials

Several classification systems categorize cements based on characteristics such as composition and chemical bonding properties. The classification of dental cements for cementing prostheses to natural abutments does not necessarily apply to implant-supported prostheses. For instance, whereas (ZOE) is used for short-term cementation during provisionalization on teeth, ZOE provides sufficient retention for CRISP. Because this article focuses on clinical applications, it is appropriate to classify dental cements as either provisional, semipermanent, or permanent ( Table 1 ).

Table 1
Clinical classification of dental cements
Provisional Semipermanent Permanent
Zinc oxide eugenol
Eugenol-free zinc oxide
Zinc phosphate
Glass ionomer
Resin-modified glass ionomer
Zinc polycarboxylate
Resin cement

Provisional cements

Provisional cements are highly soluble and show weak tensile strength. This may be advantageous when completing a provisional CRISP or recementing a prosthesis that is associated with peri-implantitis. Provisional cements allow for the retrievability of CRISP. However, CRISP may lose retention when provisional cement is used. Both ZOE and eugenol-free ZnO (EF-ZnO) are considered provisional cements. According to Ma and Fenton’s systematic review, 17.6% loss of retention of CRISP occurred when provisional cements were used. The characteristics of ZOE and EF-ZnO are addressed in Table 2 .

Table 2
Provisional cements used to retain CRISP
Cement Type Characteristics Advantages Disadvantages
  • Bactericidal

  • Soluble

  • Radiopaque

  • Weak bond to titanium

  • Lowest tensile strength

  • High pH

  • Excellent marginal seal

  • Significant reduction in periodontal pathogens

  • No residual cement, hence low incidence of peri-implantitis

  • Excess cement is easily detected.

  • Easy removal of excess cement

  • Ideal for provisionalization

  • Biocompatible

  • Less bacterial microleakage

  • Gap formation at the prosthesis-abutment interface

  • Frequent decementations

Eugenol-free zinc oxide
  • Organic acid substitutes for eugenol

  • Soluble

  • Low tensile strength

  • Low inflammatory soft tissue parameters

  • Hypoallergenic

  • Eliminate the negative effect of eugenol on resin polymerization if permanent cementation is considered

  • Low incidence of peri-implantitis

  • Higher microleakage

  • Low retention

Semipermanent cements

Semipermanent cements provide sufficient retention to resist frequent decementation and allow retrievability. Zinc phosphate (ZnP) and GI are considered semipermanent cements when used with CRISP. Semipermanent cements reduce the incidence of decementation when compared with provisional cements. When a cement’s tensile strength is between provisional and permanent cements, it is classified as a semipermanent cement. A permanent cement, such as resin cement, can be made semipermanent by mixing it with petroleum jelly. ZnP and GI offer a degree of retrievability when used with titanium or zirconia abutments. Wittneben and Bragger’s systematic review demonstrated a decementation rate of 0% for CRISP cemented with ZnP. Table 3 provides an overview of ZnP and GI characteristics.

Table 3
Commonly used semipermanent cements
Cement Type Characteristics Advantages Disadvantages
  • Tensile strength is lower than GI, but higher than EF-ZnO

  • Low viscosity

  • No adhesion to titanium or prosthesis

  • Highest elastic modulus

  • High solubility at setting time

  • Least creep

  • Highest radiopacity when compared with different luting agents

  • Inexpensive

  • Lower incidence of decementation than provisional cements

  • Flow easily for better mechanical retention

  • Highly rigid, thus suitable for areas with high occlusal forces

  • Dimensionally stable, thus no stress generation on full ceramic prostheses

  • Easy detection of excess cement

  • Excess cement removal is the easiest compared with resin and GI cements

  • Cost-effective

  • Not recommended for short abutments or prostheses with increased prosthetic-abutment gab

  • Inadequate marginal seal

  • Adequate mechanical strength, and adhesion to base metal alloys

  • Critical manipulation during setting time

  • High creep––deformation of the material with time

  • High water sorption

  • Low modulus of elasticity

  • Radiopaque

  • retention increases over time due to continued polymerization

  • Inexpensive

  • Adequate retention

  • Some brands (GC Fuji Temp LT) can be detected radiographically

  • Inadequate moisture control during setting results in high microleakage

  • Microcracks with excessive dryness during setting time

  • Dimensional instability (not recommended for full lithium disilicate ceramic crown)

  • Not recommended in areas subjected to high occlusal forces

Permanent cements

After careful evaluation of peri-implant tissue health, clinicians may wish to cement the prosthesis indefinitely. Permanent cements should have characteristics that prohibit the occurrence of any prosthetic complication. It must allow for long-term retention, peri-implant health and a desirable esthetic outcome. Resin-modified GI (RMGI), zinc PCB, and resin cements share properties of permanent cements. RMGI, PCB, and resin are used to retain permanent CRISPs. A systematic review by Chaar and colleagues revealed a decementation rate up to 4% for CRISP retained with permanent cements ( Table 4 ).

Table 4
Commonly used permanent cements for CRISP
Cement Type Characteristics Advantages Disadvantages
  • Less critical manipulation than conventional GI

  • Increased tensile and flexural strength provided by the added resin

  • Improved initial strength and less solubility compared with GI

  • Highest water sorption

  • Radiopacity is comparable with enamel

  • Different shades are available

  • Suitable for areas subjected to high occlusal forces

  • Indicated for metal, PFM, FPD, and high strength ceramics

  • Less microleakage

  • Excess cement can be detected radiographically

  • Excellent esthetics and retentive qualities

  • Dimensionally less stable (contraindicated with full ceramic prostheses)

  • Excess cement removal can be difficult if not performed quickly.

Zinc PCB
  • Good retention

  • High solubility and erosion in acidic medium

  • Weak cohesive strength

  • Deformation under pressure

  • Radiopaque at 0.5 mm thickness

  • Corrosive behavior on titanium

  • Can be used in less than ideal retentive conditions, only when excellent prosthetic fit is present

  • Excess cement can be detected

  • Loss of retention is anticipated with ill fitted prosthesis

  • Highest microleakage among dental cements

  • Sandblasting of the abutment or the prostheses does not make a significant difference.

  • Not recommended for long span prosthesis

  • Not recommended with titanium abutments

  • Insoluble and provide adhesion

  • Highest retention

  • High modulus of elasticity and flexural strength

  • Strengthen all-ceramic prostheses

  • Highly viscous

  • High water sorption, especially for unfilled resin

  • High bonding affinity to titanium

  • radiolucent

  • Lowest microleakage

  • Indicated for short abutments

  • Excellent in posterior area

  • Less fracture of all-ceramic prostheses

  • Excellent esthetics

  • High incidence of peri-implantitis when excess cement is not removed

  • High viscosity might prevent complete seating of the prosthesis, thus leading to marginal discrepancy or fracture of the veneering ceramic

  • Removal of excess cement is not easy after setting of the cement

  • Excess cement is not detected radiographically

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Apr 27, 2020 | Posted by in General Dentistry | Comments Off on What is the Best Available Luting Agent for Implant Prosthesis?

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