26 April 2023

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Selective adhesive luting: a hybrid technique for universal resin cements

Lorenzo Breschi

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Adhesive dentistry has made immense advancements in the last two decades thanks to the improved material’s technologies. Universal resin cements (URCs) represent the latest innovation in dental market and reflects the trend of simplification of operative techniques without sacrificing the efficacy. URCs can be employed in a vast array of clinical situations either in the self-adhesive mode or, with the aim of increasing bond-strength, in combination with their respective adhesive system. Thanks to their versatility, URCs can be appealing in challenging situations where cementation with rubber dam is difficult to achieve, such as short abutments and/or subgingival crown preparations.

In this regard, Breschi et al. introduced the concept of “Selective Adhesive Luting — SAL,” a hybrid technique to exploit the benefits of URCs, relying on simultaneous adhesive and self-adhesive luting of indirect restorations. In this paper published in the Journal of Esthetic and Restorative Dentistry, a laboratory study supported by clinical photographs is presented to introduce the SAL concept technique.

Materials and methods

Two commercially available URCs, RelyX Universal (3M, Oral Care, St Paul, MN, USA) and Panavia SA Cement Universal (Kuraray Noritake Dental Inc, Okayama, Japan) were utilized in self-adhesive mode and in combination with their respective universal adhesive systems applied either on the entire bonding interface or on 50% of the bonding interface (SAL technique). Adhesive properties were analyzed with a shear bond strength (SBS) test and failure mode of the tested specimens was analyzed by scanning electron microscopy (SEM). For all statistical tests, the significance level was set at p<0.05.

Results

The type of cement, the adhesive strategy and their interactions significantly influenced the SBS to enamel and dentin (p<0.05). Both URCs performed better when used in combination with their respective adhesive systems than in the self-adhesive mode (p<0.05); in particular, RelyX Universal demonstrated higher SBS values compared to Panavia SA Cement Universal (p<0.05), regardless of the percentage of bonding surface covered with the adhesive (50% or 100%). Researchers observed a prevalence of mixed failure among groups.

Conclusion

Supported by preliminary laboratory evidence, the authors concluded that the SAL technique is highly recommended, as it can enhance the quality of adhesion achieving a more reliable cementation of indirect restorations. In clinical situations where rubber dam isolation is difficult, the adhesive system should be selectively applied onto tooth surfaces easily accessible and controllable from saliva and blood contamination: in this portion of the tooth, adhesive luting can be performed, whereas the rest of surfaces are subjected to the self-adhesive luting. Further laboratory and clinical trials are required to evaluate the long-term performance of this novel technique.

Breschi L, Josic U, Maravic T, Mancuso E, Del Bianco F, Baldissara P, Mazzoni A, Mazzitelli C. “Selective adhesive luting: A novel technique for improving adhesion achieved by universal resin cements.” J Esthet Restor Dent. 27 March 2023.