A bioactive dental luting cement--its retentive properties and 3-year clinical findings

A clinical validation study was conducted to determine the performance of a new bioactive dental cement (Ceramir C&B, Doxa Dental AB) for permanent cementation. The cement is a new formulation class, which is a hybrid material comprised of calcium aluminate and glass-ionomer components. A total of 38 crowns and bridges were cemented in 17 patients; 31 of the abutment teeth were vital and seven were non-vital. Six restorations were bridges with a total of 14 abutment teeth (12 vital/ two non-vital). One fixed splint comprising two abutment teeth was also included. Preparation parameters were recorded, as well as cement characteristics such as working time, setting time, seating characteristics, and ease of cement removal. Baseline data were recorded for the handling of the cement, gingival inflammation, and pre-cementation sensitivity. Post-cementation parameters included post-cementation sensitivity, gingival tissue reaction, marginal integrity, and discoloration. All patients were seen for recall examinations at 30 days and 6 months. Fifteen of 17 subjects and 13 of 17 patients were also available for subsequent comprehensive 1- and 2-year recall examination, and 13 patients were available for a 3-year recall examination. Restorations available for the 3-year recall examination included 14 single-unit full-coverage crown restorations, four three-unit bridges comprising eight abutments, and one two-unit splint. Three-year recall data yielded no loss of retention, no secondary caries, no marginal discolorations, and no subjective sensitivity. All restorations rated excellent for marginal integrity. Average visual analogue scale (VAS) score for tooth sensitivity decreased from 7.63 mm at baseline to 0.44 mm at 6-month recall, 0.20 mm at 1-year recall, and 0.00 mm at 2- and 3-year recall. Average gingival index (GI) score for gingival inflammation decreased from 0.56 at baseline to 0.11 at 6-month recall, 0.16 at 1-year recall, 0.21 at 2-year recall, and 0.07 at 3-year recall. After periodic recalls up to 3 years, Ceramir C&B thus far has performed quite favorably as a luting agent for permanent cementation of permanent restorations. In-vitro crown-coping retention studies were also conducted using this cement and various control cementation materials. Mean laboratory retentive forces measured for Ceramir C&B were comparable to other currently available luting agents for both metal and all-ceramic indirect restorative materials.