Dr. Mark Latta

Bisco’s DUO-LINK composite luting cement is a dual-cured, highly filled cement and competes in a very crowded and often confusing product niche in restorative dentistry.

DUO-LINK is not a newly-introduced product, but one that has had a long history of producing excellent clinical results. So why is this product of such great interest today? Selecting the ideal cement from the pure resin, self-adhesive resin, glass ionomer categories with all-ceramic, metal ceramic and post cementation procedures is a challenge and most clinicians use multiple materials in their day-to-day treatment.

DUO-LINK shines as a versatile cement for numerous clinical indications when the doctor demands a dual-cured chemistry for the clinical procedure. It is suited for adhesive cementation of metal supported porcelain-fused-to-metal crowns and bridges, crowns, inlays and onlays fabricated from metal, composite resin or ceramics, and metal and fiber-reinforced endodontic posts.

In looking at what makes DUO-LINK stand out as a luting material, it is important to understand that many cements do not cure equally as well in the purely light-cured mode compared to the self-cured mode. For many clinical situations it is not possible to get light penetration through the restoration to the deepest part of the cement layer. The integrity of the cement (and the restoration itself) then is dependent on the chemical curing components to achieve a high degree of conversion (cure) without light exposure. DUO-LINK achieves a very high degree of conversion in both the self- and light-cure modes, independent of each other. The physical properties of DUO-LINK also are excellent and balance a high filler content for marginal wear resistance with a low film thickness and flow to ensure ease of cementation.

		95% of the Catapult evaluators would use Bisco DUO-LINK cement for at least some clinical indications in their practices. In situations where adhesive cementation is required, such as with single all-ceramic restorations made from a feldspathic or leucite ceramic (i.e. Empress I) or when there is a compromised retention form, this material (in conjunction with a compatible adhesive system) would be a material of choice.

		81% of the evaluators rated the flow characteristics of the cement as “just right” with less than 5% feeling the working time was too short. This characteristic is critical to ensure full and complete seating of the restoration to achieve the best marginal adaptation. The film thickness of the cement was rated either very good or excellent by more than 75% of the evaluators.

		The majority of evaluators rated the automix delivery system as close to ideal in terms of extrusion force and the quantity of material in the delivery system. The delivery system was especially noted for creating a minimal amount of wasted material.

		62% of the evaluators found the cement working time to be “just right” with fewer than 5% who felt the working time was too short. Favoring a slightly longer working time is better in most clinical situations to eliminate the chance for incompletely seating a restoration.

		Clean-up of the excess cement also was rated very highly by the Catapult evaluators. On a 1-7 scale where 1 represented ‘easy’ and 7 ‘very difficult,’ clean-up in the self-cure mode was rated 2.8 and in the light- cure mode 2.9-both excellent scores. As with all resin based cements, the timing of cement removal in the light-cured mode is dependent on the power of the light used. A bench trial of the cement and the light to be used clinically can help the clinician gauge the appropriate clean-up timing.

DUO-LINK is available in a translucent shade and as such would not provide significant color modification to the final restoration. While certainly this cement can be used for cementing veneers, for achieving significant color stability a light-cure only cement such as CHOICE 2 would be preferred.

The very high percentage (95%) of evaluators that would incorporate this cement into their practices is impressive and reflects the very good physical properties and the well accepted handling characteristics of this cement. While certainly it would not be the definitive choice for cementing all indirect restorations, it represents a terrific option when an adhesive cementation technique is indicated.

DUO-LINK is designed for use with universal adhesive systems such as ALL-BOND 2, ALL-BOND 3, ONE-STEP PLUS or ALL-BOND SE. Some incompatibilities may occur with dual-cured resin cement systems and some adheesive systems, especially adhesives that are low in pH, such as most self-etching systems. Prior to using DUO-LINK with other adhesives, check with the manufacturer to be sure there are not unexpected interactions that could inhibit chemical curing of the cement.

At room temperature the working time for DUO-LINK is 2 minutes and the setting time is 5 minutes 30 seconds for dual-syringe mixed material. Both working and setting times will be accelerated by mouth temperature, and by coming into contact with some adhesive system primers, depending on the adhesive system used. When used for the first time, careful attention to the intraoral setting behavior is important to prevent the cement from setting to a point that makes removal of the excess difficult.

Promotion of adhesion of DUO-LINK to the restoration surface can be accomplished by the appropriate preparation of the metal, ceramic or composite surface and the use of a suitable bonding primer for the specific material being cemented.

This review represents a summary of the findings amongst the Catapult evaluators, who used this product to cement a wide variety of restorations. While a small minority would have preferred the cement to have a slightly shorter work/set time, the survey results show that overall there was wide acceptance of this cement, especially for adhesive cementation of ceramic restorations.

Articles

Key tips and feedback on Bisco’s DUO-LINK™ Composite Luting Cement

Many clinical situations demand a provisional restoration that must serve in function for extended time. Large fixed prosthodontic cases and implant treatment are examples of situations where an easy to handle but retentive and durable temporary cement is required.  

GC America has introduced Fuji TEMP LT provisional cement.

This is a glass ionomer based material formulated to have excellent handling characteristics and a very low film thickness. It has numerous beneficial properties that would be expected from a glass ionomer including fluoride recharging, excellent hard and soft tissue compatibility and very high mechanical strength properties.

Because of its tooth like coefficient of thermal expansion and ionic bonding to metals and tooth structure, the maintenance of a marginal seal around the provisional is enhanced. The material also is radiopaque, making detection of interproximal and gingival sulcus excess easy.

Results from a recent Catapult evaluation revealed that Fuji TEMP LT was well received and 83% of the evaluators would adopt this cement as a material of choice in their practice. Other findings from the survey included:

		The flow and film thickness at initial seating was rated as good as or better than the users’ existing cement by 100% of the evaluators; 82% rated the flow “just right.”

		The ease of clean-up at initial seating was rated as good as or better than the users’ existing cement by 88% of the evaluators.

		Retention was excellent and rated as good as or better than the cement currently used by 88% of the evaluators.

		Removal of remaining cement for the abutment or preparation was rated slightly less favorably and was as good as or better in 66% of the cases.

		83% gave the cement an overall rating of “Good” or “Excellent.”

As might be expected with a cement designed for long-term function, there was a 31% rating of nearly difficult or difficult for removal of cement from the abutment. However, this is likely a small trade off in having a highly retentive and long lasting provisional cement and may be a perfectly acceptable characteristic for a truly longer term provisional.

Fuji TEMP LT represents an important material for practitioners looking for a solution to an often difficult problem, retention of a provisional restoration for an extended period of time. This material should be considered by anyone looking for a long-term provisional cement solution.

		For single units of crowns and onlays with low retention, this cement can help reduce the hassles of lost temporaries and/or the same old, “my temporary came off” the next day.

		An added benefit of Fuji TEMP LT is that it is eugenol free, which is a consideration for many dentists when doing a final cementation.

		For high caries risk patients, if long-term use helps reduce potential caries issues or helps remineralize the tooth, that much the better to implement into your practice.

		For those patients with lower vital molars that you don’t want to numb due to sensitivity in removing the cement, (we all know the hassle of lower molars) this may not be your best option.

Suggestions to the next generation of the product

		Dual Cure, which ultimately leads to faster clean-up

		Clear color added to the options for anterior provisionalization

Catapult is an organization that consists of more than 50 clinicians spread throughout Canada and the United States. As a company, manufacturers pay a fee for their product to be evaluated and what we deliver are truthful, independent answers from surveys that we develop with them. We have had many products that have either had to be altered before hitting the market or simply never arrived because of our openly honest evaluations. In this way, Catapult assists the manufacturer to avoid potentially releasing a faulty product, or simply a product that needs refinement. Lastly our clients are omnipresent in the industry, small to large, no favoritism, simply reviewing the latest products in our practices.

Many clinical situations demand a provisional restoration that must serve in function for extended time. Large fixed prosthodontic cases and implant treatment are examples of situations where an easy to handle but retentive and durable temporary cement is required.  GC America has introduced Fuji TEMP LT provisional cement.