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Leakage of various types of luting agents
Leakage
of various
types
L. K. Mash, DDS,* C. K. Beninger, R. S. Staffanou, DDS, MSd
of luting
agents
DDS,b J. T. Bullard,
DDS,C and
Baylor College of Dentistry, Dallas, Texas Freshly extracted molar teeth were prepared for complete cast gold crowns cemented with either zinc phosphate cement, polycarboxylate cement, glass ionomer cement, a resin luting agent, or a zinc oxide-eugenol temporary cement. The specimens were tested at l-, f3-, and 12-month intervals with radioactive 46Ca. The specimens were sectioned, autoradiographs were made, and the marginal leakage was evaluated on a scale of 0 to 3. The results showed that zinc phosphate, polycarboxylate, and glass ionomer cements are equally suited for permanent cementation of restorations. The resin luting agent showed high initial leakage, indicating that it is not as desirable for permanent cementation purposes. The zinc oxide-eugenol cement showed increased leakage with time but is well suited for its indicated purpose, temporary cementation. (J PROSTHET DENT 1991;66:763-6.)
A lthough
leakage criteria are fairly well documented for the more commonly used luting agents,lb7 the newer materials are not well tested. This study compared standard luting agents, zinc phosphate cement, and polycarboxylate cement, with the newer luting agents, glass ionomer, and a resin luting agent, Biomer (L.D. Caulk, Division of Dentsply Int., Inc., Milford, Del.). Also tested was Temp-Bond temporary cement (Kerr Mfg. Co., Romulus, Mich.).
MATERIAL
AND METHODS
Seventy-five freshly extracted molar teeth were prepared and impressions made for complete cast gold crowns. The teeth were stored in distilled water at room temperature while the restorations were made, The specimens were divided into five groups of 15 castings. Each of the five groups of restorations were cemented with either Modern Tenacin (L.D. Caulk) zinc phosphate cement, Liv Cenera (GC Dental Ind. Corp., Tokyo, Japan) polycarboxylate cement, Biomer resin luting agent, GC glass ionomer lining cement (GC Dental Ind.), and Temp-Bond zinc oxide-eugenol temporary cement. All of the castings were cemented under a standard 20 kg load. Each cement group was further divided into three groups of five, which were tested for leakage at 1 month, 6 months, and 12 months, respectively. Testing was done by immersing each test group in radioactive 45Ca.8Each specimen was immersed for 4 hours in a solution of 0.1 &i/mm of the isotope’in the form of calcium chloride with the pH adjusted to ‘7.After removal from the
‘Assistant Professor, Department of Operative Dentistry. bClinical Assistant Professor, Department of Operative Dentistry. cProfessor and Chairman, Department of Operative Dentistry. dprofessor and Chairman, Department of Fixed Prosthodontics. I01 II29628
THE JOURNAL
OF PROSTHETIC
DENTISTRY
Table I. Cement leakage Degrees of leakage
Zinc phosphate 1 month 6 months 12 months Glass ionomer 1 month 6 months 12 months* Polycarboxylate 1 month 6 months* 12 months Biomer 1 month 6 months 12 months Temp Bond 1 month 6 months 12 months
0
1
2
4 4 2
1
1
2
2 4 3
2
2 4 3
3
3
2
3 4
1
1
3
1
3 4 3
1
1
1
2
Five specimenseach. *Missing
autoradiograph.
isotope, each specimen was washed with a detergent solution. The specimens were sectioned longitudinally by grinding on a wet aluminum oxide wheel. The sectioned surface of each specimen was placed on an ultraspeed periapical dental x-ray film for 12 hours to produce the autoradiograph. The films were developed in an automatic developer. Five autoradiographs per group were produced at each time interval of 1 month, 6 months, and 12 months.
763
MASH
ET AL
Fiig. 1. A, Zinc phosphate cement (Modern Tenacin) 1 month autoradiograph. Arrow indicates l-degree leakage. B, Zinc phosphate cement (Modern Tenacin) 12-month autoradiograph. Arrow indicates 2-degree leakage.
Fig. 2. A, Glass ionomer cement (GC Lining Cement) l-month autoradiograph. Arrow indicates l-degree leakage. B, Glass ionomer cement (GC Lining Cement) 12-month autoradiograph. Arrow indicates l-degree leakage. Marginal leakage at the interface of the gold and tooth surface was determined by the following scale: 0 = No evidence of isotope penetration at the interface of the gold and tooth surface 1 = Evidence af slight isotope penetration less than half the height of the exia1 wall of the preparation 2 = Evidence of isotope penetration at half the height of the axial wall of the preparation
764
3 = Evidence of isotope penetration in excessof half the height of the axial wall and extending to the occlusal aspect of the preparation
Table I shows the results of this study.
DISCUSSION After 1 month two specimens of glass ionomer and two specimens of polycarboxylate cements out of five showed
DECEMBER
1991
VOLUME
66
NUMBER
6
LEAKAGE
OF LUTING
AGENTS
Fig. 3. A, Polycarboxylate cement (Livcenera) l-month autoradiograph. Arrow indicates l-degree leakage.B, Polycarboxylate cement (Livcenera) la-month autoradiograph. Arrow indicates l-degree leakage.
Fig. 4. A, Resin luting agent (Biomer) l-month autoradiograph. Arrow indicates l-degree leakage. B, Resin luting agent (Biomer) 12-month autoradiograph. Arrow indicates 2-degree leakage. no leakage, two showed level 1 leakage, and one showed level 2 leakage. Four specimens of zinc phosphate cement showed level 1 leakage and one specimen showed level two leakage.Biomer resin luting agent showed three specimens with level 1 leakage and one with levels 2 and 3 leakage, respectively. Temp-Bond temporary cement showed one specimen with level one, three with level two, and one with level three leakage. (Figs. 1, A, 2, A, 3, A, 4, A, 5, A.). After 6 months, zinc phosphate cement showed one specimen with no leakage and four with level 1 leakage.
THE
JOURNAL
OF PROSTHETIC
DENTISTRY
Glass ionomer cement showed four specimens with level 1 and one with level 2 leakage. Polycarboxylate cement showed four specimens with level 1 leakage; the fifth radiograph was missing. Biomer luting agent showed four specimenswith level 1 and one with level 2 leakage. TempBond cement showed one specimen with level 1 and four with level 2 leakage. Six-month autoradiographs were omitted becausethere was little significant changefrom the l-month results. At 12 months, zinc phosphate cement showed two spec-
765
MASH
ET AL
F ig. 6. A, Zinc oxide-eugenol cement (Temp-Bond) l-month autoradiograph. Arrow indicates 243egreesleakage. B, Zinc oxide-eugenol cement (Temp-Bond) la-month autoradiograph. Arrow indicates 3-degree leakage. imens with level 1 and three with level 2 leakage. Glass ionomer cement showed three wcimens with level 1 leakage and one v&h level 2; the fifth radiograph was missing. The polycarboxyfate cement showed three specimens with . Biomer luting agent level 1 and~two with level 2 showed onespecimen at level 1, three at level 2, and one at level 3 leakage. Temp.Bond cement showed three specimens at levei 2 and two at level 3 leakage (Figs. 1, B, 2, B, 3, B, 4, B; 5, B).
On the basis of leakage, there wee little difkmce among zinc phosphate, gkse ion-r, and polycarkylate cements. Biomer lutingagent had ~~~y~r leakage at all intervals. Temp-Bond cement had moderately high leakage at all intervals, hecoming consistently higher with time, but did not have aigni&antly greater leakage than Biomer cement. Temp-Bond and Biomer cements only showed leakage at the level 3 category. Zinc phoeph&e, gtaaaion-r, and polycarboxylate cements are equaBy well suited for permanent cementation of restorations. Biomer luting agent showed high initial leakageand ia probably not desirable for final cementation. Tamp-Bond cement had increased leakage with time but is suited for ita indicated purpose, short-term temporary cementation.
REFERENCES 1. Swartz ML, Phillips RS. In vitro studies on the marginal leakageof restorative materials. J A m Dent Aasoc 1961:62:141-51. 2. Richter WA, Veno H. Clinical evaluation of dental cement durability. J Pro&et Dent 1975;33:294-9. 3. Andrew JT, HembreeJH. In vivo evaluation of marginal leakageof four inlay cements. J Prosthet Dent 197635352-6. 4. Mitchem JC, Gronaa DG. Clinical evaluation of cement solubility. J Prosthet Dent 1978;40:453-6. 5. Osborne JW, Swartz ML, Goodacre CJ, Phillips RW, Gale EN. A method of assessingthe clinical solubility and disintegration of luting cements. J Prcethet Dent 1978;40:413-7. 6. Mondelli CD, Ishihiriama A, Junior JG. Marginal microlealragein cemented complete crowne. J Prosthet Dent 1978;40:632-6. 7. Iwahu hi, Takatau T, FusayamaT. Comparison of three luting agents. J Prosthet Dent 1980~48:423-6. 8. Phillips RW, Gllmore HW, Swartz ML, Schenker SI. Adaptation of restorations in vivo as assessedby Ca*. J A m Dent Assoc 1961;62:9-20. Reprint requests to: DR. L. K. MC~H BAYLORCOLLEOE OF DENTISTRY 3302 GASTON AVE. DALLAS, TX 75246
Contributing author 6. Hembree, Jr., DDS, Dean, University of Mississippi, School of Dentistry, Jackson, Miss.
DECEMBER
1991
VOLUME
66
NUMBER
6
of various
types
L. K. Mash, DDS,* C. K. Beninger, R. S. Staffanou, DDS, MSd
of luting
agents
DDS,b J. T. Bullard,
DDS,C and
Baylor College of Dentistry, Dallas, Texas Freshly extracted molar teeth were prepared for complete cast gold crowns cemented with either zinc phosphate cement, polycarboxylate cement, glass ionomer cement, a resin luting agent, or a zinc oxide-eugenol temporary cement. The specimens were tested at l-, f3-, and 12-month intervals with radioactive 46Ca. The specimens were sectioned, autoradiographs were made, and the marginal leakage was evaluated on a scale of 0 to 3. The results showed that zinc phosphate, polycarboxylate, and glass ionomer cements are equally suited for permanent cementation of restorations. The resin luting agent showed high initial leakage, indicating that it is not as desirable for permanent cementation purposes. The zinc oxide-eugenol cement showed increased leakage with time but is well suited for its indicated purpose, temporary cementation. (J PROSTHET DENT 1991;66:763-6.)
A lthough
leakage criteria are fairly well documented for the more commonly used luting agents,lb7 the newer materials are not well tested. This study compared standard luting agents, zinc phosphate cement, and polycarboxylate cement, with the newer luting agents, glass ionomer, and a resin luting agent, Biomer (L.D. Caulk, Division of Dentsply Int., Inc., Milford, Del.). Also tested was Temp-Bond temporary cement (Kerr Mfg. Co., Romulus, Mich.).
MATERIAL
AND METHODS
Seventy-five freshly extracted molar teeth were prepared and impressions made for complete cast gold crowns. The teeth were stored in distilled water at room temperature while the restorations were made, The specimens were divided into five groups of 15 castings. Each of the five groups of restorations were cemented with either Modern Tenacin (L.D. Caulk) zinc phosphate cement, Liv Cenera (GC Dental Ind. Corp., Tokyo, Japan) polycarboxylate cement, Biomer resin luting agent, GC glass ionomer lining cement (GC Dental Ind.), and Temp-Bond zinc oxide-eugenol temporary cement. All of the castings were cemented under a standard 20 kg load. Each cement group was further divided into three groups of five, which were tested for leakage at 1 month, 6 months, and 12 months, respectively. Testing was done by immersing each test group in radioactive 45Ca.8Each specimen was immersed for 4 hours in a solution of 0.1 &i/mm of the isotope’in the form of calcium chloride with the pH adjusted to ‘7.After removal from the
‘Assistant Professor, Department of Operative Dentistry. bClinical Assistant Professor, Department of Operative Dentistry. cProfessor and Chairman, Department of Operative Dentistry. dprofessor and Chairman, Department of Fixed Prosthodontics. I01 II29628
THE JOURNAL
OF PROSTHETIC
DENTISTRY
Table I. Cement leakage Degrees of leakage
Zinc phosphate 1 month 6 months 12 months Glass ionomer 1 month 6 months 12 months* Polycarboxylate 1 month 6 months* 12 months Biomer 1 month 6 months 12 months Temp Bond 1 month 6 months 12 months
0
1
2
4 4 2
1
1
2
2 4 3
2
2 4 3
3
3
2
3 4
1
1
3
1
3 4 3
1
1
1
2
Five specimenseach. *Missing
autoradiograph.
isotope, each specimen was washed with a detergent solution. The specimens were sectioned longitudinally by grinding on a wet aluminum oxide wheel. The sectioned surface of each specimen was placed on an ultraspeed periapical dental x-ray film for 12 hours to produce the autoradiograph. The films were developed in an automatic developer. Five autoradiographs per group were produced at each time interval of 1 month, 6 months, and 12 months.
763
MASH
ET AL
Fiig. 1. A, Zinc phosphate cement (Modern Tenacin) 1 month autoradiograph. Arrow indicates l-degree leakage. B, Zinc phosphate cement (Modern Tenacin) 12-month autoradiograph. Arrow indicates 2-degree leakage.
Fig. 2. A, Glass ionomer cement (GC Lining Cement) l-month autoradiograph. Arrow indicates l-degree leakage. B, Glass ionomer cement (GC Lining Cement) 12-month autoradiograph. Arrow indicates l-degree leakage. Marginal leakage at the interface of the gold and tooth surface was determined by the following scale: 0 = No evidence of isotope penetration at the interface of the gold and tooth surface 1 = Evidence af slight isotope penetration less than half the height of the exia1 wall of the preparation 2 = Evidence of isotope penetration at half the height of the axial wall of the preparation
764
3 = Evidence of isotope penetration in excessof half the height of the axial wall and extending to the occlusal aspect of the preparation
Table I shows the results of this study.
DISCUSSION After 1 month two specimens of glass ionomer and two specimens of polycarboxylate cements out of five showed
DECEMBER
1991
VOLUME
66
NUMBER
6
LEAKAGE
OF LUTING
AGENTS
Fig. 3. A, Polycarboxylate cement (Livcenera) l-month autoradiograph. Arrow indicates l-degree leakage.B, Polycarboxylate cement (Livcenera) la-month autoradiograph. Arrow indicates l-degree leakage.
Fig. 4. A, Resin luting agent (Biomer) l-month autoradiograph. Arrow indicates l-degree leakage. B, Resin luting agent (Biomer) 12-month autoradiograph. Arrow indicates 2-degree leakage. no leakage, two showed level 1 leakage, and one showed level 2 leakage. Four specimens of zinc phosphate cement showed level 1 leakage and one specimen showed level two leakage.Biomer resin luting agent showed three specimens with level 1 leakage and one with levels 2 and 3 leakage, respectively. Temp-Bond temporary cement showed one specimen with level one, three with level two, and one with level three leakage. (Figs. 1, A, 2, A, 3, A, 4, A, 5, A.). After 6 months, zinc phosphate cement showed one specimen with no leakage and four with level 1 leakage.
THE
JOURNAL
OF PROSTHETIC
DENTISTRY
Glass ionomer cement showed four specimens with level 1 and one with level 2 leakage. Polycarboxylate cement showed four specimens with level 1 leakage; the fifth radiograph was missing. Biomer luting agent showed four specimenswith level 1 and one with level 2 leakage. TempBond cement showed one specimen with level 1 and four with level 2 leakage. Six-month autoradiographs were omitted becausethere was little significant changefrom the l-month results. At 12 months, zinc phosphate cement showed two spec-
765
MASH
ET AL
F ig. 6. A, Zinc oxide-eugenol cement (Temp-Bond) l-month autoradiograph. Arrow indicates 243egreesleakage. B, Zinc oxide-eugenol cement (Temp-Bond) la-month autoradiograph. Arrow indicates 3-degree leakage. imens with level 1 and three with level 2 leakage. Glass ionomer cement showed three wcimens with level 1 leakage and one v&h level 2; the fifth radiograph was missing. The polycarboxyfate cement showed three specimens with . Biomer luting agent level 1 and~two with level 2 showed onespecimen at level 1, three at level 2, and one at level 3 leakage. Temp.Bond cement showed three specimens at levei 2 and two at level 3 leakage (Figs. 1, B, 2, B, 3, B, 4, B; 5, B).
On the basis of leakage, there wee little difkmce among zinc phosphate, gkse ion-r, and polycarkylate cements. Biomer lutingagent had ~~~y~r leakage at all intervals. Temp-Bond cement had moderately high leakage at all intervals, hecoming consistently higher with time, but did not have aigni&antly greater leakage than Biomer cement. Temp-Bond and Biomer cements only showed leakage at the level 3 category. Zinc phoeph&e, gtaaaion-r, and polycarboxylate cements are equaBy well suited for permanent cementation of restorations. Biomer luting agent showed high initial leakageand ia probably not desirable for final cementation. Tamp-Bond cement had increased leakage with time but is suited for ita indicated purpose, short-term temporary cementation.
REFERENCES 1. Swartz ML, Phillips RS. In vitro studies on the marginal leakageof restorative materials. J A m Dent Aasoc 1961:62:141-51. 2. Richter WA, Veno H. Clinical evaluation of dental cement durability. J Pro&et Dent 1975;33:294-9. 3. Andrew JT, HembreeJH. In vivo evaluation of marginal leakageof four inlay cements. J Prosthet Dent 197635352-6. 4. Mitchem JC, Gronaa DG. Clinical evaluation of cement solubility. J Prosthet Dent 1978;40:453-6. 5. Osborne JW, Swartz ML, Goodacre CJ, Phillips RW, Gale EN. A method of assessingthe clinical solubility and disintegration of luting cements. J Prcethet Dent 1978;40:413-7. 6. Mondelli CD, Ishihiriama A, Junior JG. Marginal microlealragein cemented complete crowne. J Prosthet Dent 1978;40:632-6. 7. Iwahu hi, Takatau T, FusayamaT. Comparison of three luting agents. J Prosthet Dent 1980~48:423-6. 8. Phillips RW, Gllmore HW, Swartz ML, Schenker SI. Adaptation of restorations in vivo as assessedby Ca*. J A m Dent Assoc 1961;62:9-20. Reprint requests to: DR. L. K. MC~H BAYLORCOLLEOE OF DENTISTRY 3302 GASTON AVE. DALLAS, TX 75246
Contributing author 6. Hembree, Jr., DDS, Dean, University of Mississippi, School of Dentistry, Jackson, Miss.
DECEMBER
1991
VOLUME
66
NUMBER
6