Adhesive luting of indirect restorations

To describe the potential of adhesive luting procedures with respect to (1) material characteristics and classifications, (2) film thickness, (3) overhang control, (4) bonding to different inlay materials, (5) adhesion to tooth substrates and the problem of hypersensitivities, (6) wear of luting composites, and (7) clinical performance.

A literature review of relevant studies of various in vitro and in vivo studies enables an overview of possibilities and limitations of adhesively luted indirect restorations.

(1) Resin-based composites are the material of choice for adhesive luting. Both material properties and wear behavior of fine particle hybrid-type resin-based composites are superior to other materials. The use of compomers is questionable due to hygroscopic expansion and possible crack formation as proven for IPS Empress caps in vitro and in vivo. (2) Recent luting cements exhibit excellent flow characteristics with mean film thicknesses ranging between 8 microm and 21 microm. The ultrasonic insertion technique is recommended for viscous luting composites or conventional restorative composites utilizing their thixotropic properties. (3) For successful overhang control, good fit of the restoration (during luting) and high radiopacity of the cement (after luting) are indispensable. Overhang control is estimated easier when the ultrasonic insertion technique is applied. (4) The pre-treatments of ceramic inlays using hydrofluoric acid or silica coating result in effective bonding; for pre-treatment of resin-based composite inlays, silica coating is promising as well. (5) Bonding to enamel and dentin is proven clinically acceptable, but it should be performed with multi-step systems providing separate primers and bonding agents producing a perfect internal seal with almost no hypersensitivities. Dual-cured multi-step bonding agents provide the most promising potential. (6) The viscosity and filler content of the resin composite used for luting does not influence the wear characteristics within the marginal luting area in vivo. However, the ultrasonic insertion technique involving high viscosity materials provides enhanced handling characteristics for luting of tooth-colored inlays. (7) Clinical results with tooth-colored inlays and veneers are promising over periods of up to 10 yrs, including use in severely destroyed teeth.