[Downloaded free from http://www.dmrjournal.org on Thursday, January 22, 2015, IP: 41.254.8.

33]  ||  Click here to download free Android application for this journal

R eview A r t i cl e
Rely‑X unicem self‑adhesive universal resin
cement
Saleh Zidan, Syed Wali Peeran1, Karthikeyan Ramalingam2
Department of Dental Materials, Faculty of Dental Materials, Sebha University, 1Departments of Periodontology and Oral Implantology and 2Oral
Pathology and Microbiology, Faculty of Dentistry, Sebha University, Sebha, Libya

Abstract
There is an expansive usage of adhesives in all branches of dentistry. Newer adhesives can be more beneficial to the
patients. This review attempts to highlight the important features of adhesive cements in general and emphasize the
applications of Rely‑X Unicem cement.

Key words: Rely‑X Unicem, self‑adhesive cements, universal resin cements

INTRODUCTION Rely‑X self‑adhesive cement is an all in one adhesive in which

The use of adhesives in the field of dentistry has grown
extensively. Beside the quantitative growth, the products
have gone through the process of significant qualitative
enhancements. New and different types of adhesive
materials are introduced that could offer many advantages
that will deliver large advantages to both patients and
dentists.
The capability of adhesive resin cements to link to both
tooth structure and restoration is a valuable quality. “The
integration produces reinforcement of both structures and
reduces microleakage at the restoration‑tooth interface,
postoperative, marginal staining and recurrent caries.”[1]
Access this article online
Quick Response Code:
Website:
www.dmr.org
these three bonding processes come together into a single
step.[2]
Rely‑X Unicem Self‑adhesive Universal Resin Cement
( Rely‑X Unicem), from 3M ESPE, United States provides
a significant step in this direction. The overall advantages
of Rely‑X Unicem are that it combines the advantages of
conventional cements and modern composite cements.
Both Rely‑X Unicem and glass ionomer cements release
fluoride ions into the tooth substance. As a result of its good
self‑adhesive bonding quality there is no need for costly and
lengthy procedures with Rely‑X Unicem, and this provides
a lot more comfort to the patient and is far more efficient
to the dentist. The disadvantage of Rely‑X Unicem is that it
is a relatively new product and therefore lacks a long period
of clinical experience.[3]
DEVELOPMENT OF ADHESIVES

Adhesives were introduced to dentistry in the 1950’s by

DOI: studies of bonding enamel and dentin.[4] The acrylic resins filled
10.4103/2348-1471.149561 with silica particles were adhered to the surface enamel that
had been etched with acid. In early years, the major problem

Address for correspondence:

Dr. R. Karthikeyan, Department of Oral Pathology and Microbiology, Faculty of Dentistry, Sebha University, Sebha, Libya.
E‑mail: drrkn79@gmail.com

Dentistry and Medical Research| Jan-Jun 2015 | Vol 3 | Issue 1 3

[Downloaded free from http://www.dmrjournal.org on Thursday, January 22, 2015, IP: 41.254.8.33]  ||  Click here to download free Android application for this journal
Zidan, et al.: Rely-X unicem
of resin‑based adhesives was their hydrolysis. The hydrolysis
leads to a lack of bond between materials and tooth surfaces,
as well as degradation of the bridge or dental filling that on
its turn could cause caries. The improvement of adhesive
techniques to bond materials to teeth is highly desirable
in dentistry because dental applications require excellent
adhesive qualities.[5]
In terms of clinical uses, these can be defined into two
categories: The first system contains a phosphoric acid etching
for enamel and a bottle of adhesive resin. The second system
contains a self‑etching primer which combines the etching
and priming in one procedure, so called self‑adhesive resin
cement.[6]
Self‑adhesive resin cement (Rely‑X Unicem; 3M ESPE) requires
one step, in contrast to other etching adhesive systems,
which involve a multi‑step application technique and are,
therefore, more time‑consuming. “The self‑adhesive resin
cement is based on a new monomer, filler, and initiation
technology. The manufacturer purports that the organic
matrix consists of newly developed multifunctional phosphoric
acid methacrylates. The phosphoric acidic methacrylates
can react with the basic fillers in the luting cement and the
hydroxyapatite of the hard tooth tissue.”[1]
PRINCIPLES OF ADHESION
Adhesion is the procedure of building adhesive joints between
two surfaces. The first surface is called adherent 1 and the
second surface is called adherent 2. The material between
them is called adhesive material. Thus, the joining of the two
adherents through an adhesive material will produce two
interfaces. Such two‑interface joints are the most common
type used in dentistry.[4]
Anusavice defined dental adhesion as “when two substances
are brought, or are attracted to, molecules of other, the
molecules of one substance adhere, or are attracted to,
molecules of the other substance.” Anusavice refers to
adhesion as a situation in which unlike molecules are attracted,
and cohesion when molecules of the same kind are attracted.
He refers to the material or film used to cause adhesion as
the adhesive and to the material to which it is applied as the
adherent.[7]
The most chemical adhesion between two phases is based
on chemical bonding. If this bond is very strong across an
interface, it will increase the attachment that gives good
adhesion.[8]
Chemical bonds are divided into interatomic primary bonds
and interatomic secondary bonds “the forces that hold atoms
together are called cohesive forces. These interatomic bonds
Dentistry and Medical Research| Jan-Jun 2015 | Vol 3 | Issue 1
may be classified as primary or secondary. The strength of
these bonds and their ability to reform
after breakage determine the physical properties of a material.”
There are three different types of primary atomic bonds: Ionic,
covalent and metallic. For interatomic secondary bonds, there
are two types of hydrogen bonding and secondary bonding.[7]
Mechanical adhesion relies on mechanical interlocking of two
phases that include microscopic attachments. That can be
seen when resin bonds to etched enamel. Stresses occur in
porcelain crowns around the metal core.[8]
However, if the thermal expansion coefficient is different
between adhesive and substrate, the difference in temperature
will produce stresses in the bond.[8] Diffusion bonding results
when one phase penetrates by diffusion into the surface of the
second phase and forms a “hybrid” layer, which is a composite
of the two materials.[8]
Adhesive materials have been used to bond the metal surface
of crowns and bridges with teeth surfaces in order to create
the best retention between them. It is difficult to place a
crown or bridge without adhesive materials.[9]
Orthodontic brackets and bands have been bonded to tooth
structures using adhesive materials. To bond orthodontic
brackets on the tooth surface, the acid etching technique has
to be used. This technique was discovered over 40 ago by
Buonocore and involves the cure of the tooth surface with
phosphoric acid for the brackets to bond [Table 1].[10]
Rely‑X Unicem has been created as a result of the need for
adhesive luting cement that has wide application in dentistry
for cementation of crowns, bridges, indirect restorative and
orthodontic. Rely‑X Unicem has better mechanical properties
and excellent adhesion and esthetics when compared to other
cements. A study by 3M ESPE (2002) has shown that Rely‑X
Unicem tolerates the moisture and releases fluoride ions, as
well as the process of cure requires only one step, accordingly
there is no need for etching and removal of the smear layer.[11]
The 3M ESPE has reported that “the existence of at least
two phosphoric acid groups and a minimum of two c  =  c
double bond units per molecule are typical for the monomers
in Rely‑X Unicem and this supplies high reactivity as well
as the matrix’ high degree of cross linking. This leads to
excellent mechanical properties and an adhesive bond without
pretreatment that has long period stability (3M ESPE Technical
Product Profile 2002).[11]
The new initiator system had to meet other requirements:
Effectiveness in light and self‑curing, moisture tolerance,
resistant to a wide pH range and a high degree of cross‑linking
of the monomer matrix. Achieving excellent bonds by Rely‑X
4
[Downloaded free from http://www.dmrjournal.org on Thursday, January 22, 2015, IP: 41.254.8.33]  ||  Click here to download free Android application for this journal

Zidan, et al.: Rely-X unicem

Table 1: Comparison between different types of luting cements with their right applications and weaknesses
(from 3M ESPE 2005)
Strengths of luting cement Areas of application Weaknesses
Zinc phosphate cement
Over 100 years of clinical experience Routine application in metal Occasional postoperative sensitivity
supported crowns and bridges Low hardness
High solubility
Polycarboxylate cement
25 years of clinical experience Acceptable for retention of metal High solubility
Low fluoride ion release supported crowns and bridges Low hardness
Molecular bonding to the tooth surface Long‑term provisional restorations
Low postoperative sensitivity
Conventional glass ionomer cement
20 years of clinical experience Routine application for metal Occasional postoperative sensitivity
Fluoride ion release supported crowns and bridges Sensitive to water and mechanical
Molecular bonding to the tooth surface Limited application with high loading
Minimal dimensional charge strength ceramics Solubility
Simplicity of use
Medium material strength
Good routine cement
Resin‑modified glass ionomer cement
10 years of clinical experience Routine application for metal Moisture sensitive powder
Fluoride ion release supported crowns and bridges Swelling/linear expansion
Molecular bonding to tooth surface Limited application with high
Low solubility or erosion of cement margins strength ceramics
Simplicity of use
Medium material strength
Good routine cement
Low postoperative sensitivity
Compomer cements
Easy technique Metal‑supported restorations Little long‑term experience
Good adhesive qualities(with pretreatment: etching, Most all‑ceramic systems Moisture sensitive
priming, bonding) Indirect composite restorations Low or no fluoride release
Low solubility Lining material
Good mechanical properties
Resin cements (composite)
10-20 years of clinical experience Emergency provisional restoration Difficult to use
High adhesion with use of pretreatments All metal‑based, ceramic and Requires use of separate primers
(etching, priming, bonding) indirect composite restorations or adhesives
High hardness Difficult to clean up
Low solubility Technique sensitive
High mechanical properties No or little fluoride release
Good esthetics
Self‑adhesive resin cement (Rely‑X Unicem
Self‑Adhesive Resin Cement from 3M ESPE)
New self‑adhesive technology All metal‑based, ceramic and Potential for postoperative
High adhesion without use of etchant, primer or adhesive indirect composite restorations sensitivity
with the exception of veneers Limited long‑term clinical history
Ease of use
Capsule delivery system Available only in capsule delivery
Low potential for postoperative sensitivity Low fluoride release
High hardness
Low solubility
High mechanical properties
Good esthetics
Easy clean up

Self Adhesive on tooth surfaces, involves a setting reaction APPLICATIONS

that is a radical polymerization reaction. From this reaction,
3M ESPE has pointed out that we can obtain two advantages,
which are the release of fluoride and the intelligent switch
to a hydrophobic matrix (3M ESPE Technical Product Profile
2002).[11]
The use of Rely‑X Unicem in operative and prosthodontic
applications without etching the enamel or dentin was
evaluated by Bishara et al.[12] In a study by De Munck et al. it
has been reported that resin based adhesive luting materials

Dentistry and Medical Research| Jan-Jun 2015 | Vol 3 | Issue 1 5

[Downloaded free from http://www.dmrjournal.org on Thursday, January 22, 2015, IP: 41.254.8.33]  ||  Click here to download free Android application for this journal
Zidan, et al.: Rely-X unicem
are widely used for the fixation of inlays and onlays, crowns,
bridges, posts and veneers. They were all resin cements
that relied on the use of an etch adhesive with multi‑step
application technique, which is complex and slightly technique
sensitive. However, recently a new technique of resin‑based
cement has been marketed that incorporates the use of
adhesive and cement in one single application.[13]
The first self‑adhesive universal resin cement designed for
universal application is Rely‑X Unicem. It is presented in
capsules that can be used for adhesive cementation of indirect
ceramic, composite and metal based restoration as well as
crowns and bridges  (3M ESPE Technical Product Profile
2002).[11]
PROPERTIES OF RELY‑X
A study by Piwowarczyk et al. has evaluated microleakage in
full cast crown restoration bonded with Rely‑X Unicem Self
Adhesive Resin Cement in enamel and dentin. The smallest
degree of micro leakage that was noted can be compared
with that of other adhesive cements, such as Rely‑X ARC and
Panavia F. The study of Rely‑X Unicem Self‑Adhesive cement
concluded that it can be used for long term cementation for
many applications as well as offer good adhesion.[14]
In a study by Behr et  al., it has been reported that the
marginal adaptation of ceramic crowns on dentin using Rely‑X
Self‑Adhesive resin cement, without pretreatment and one
step compared with other adhesive systems, is good.[15] The
evaluation of marginal quality after the stress test in the
mastication simulator exhibited excellent results in marginal
quality and density by Rely‑X Unicem compared to other
adhesive systems.
Another study by 3M ESPE  (2003) has shown a superb
marginal integrity after constant load. Rely‑X Unicem is easy
to apply in tooth structures, like ceramic inlays. Ceramic
inlays have shown good quality of marginal seal and abrasion
characteristics during thermocycling and mechanical load.[16]
The fit of a precision indirect restoration is highly dependent
on the thickness of the cement film. When the thickness
is too high, tight fitting restorations may suffer from open
margins and misalignment as a result of not being able to seat
well enough. A low film thickness is desirable for tight fitting
indirect restorations, as it allows them to seat completely. In
case of light cured restorations under indirect restorations
and for endodontic posts, extra layers of the adhesive should
not be applied and pooling should be avoided in the areas that
could potentially be of influence to the fit.[16]
Properties of water absorption and expansion of Rely‑X
Unicem cement can lead to clinical problems with indirect
Dentistry and Medical Research| Jan-Jun 2015 | Vol 3 | Issue 1
restorations, like fixed crowns and bridges that should have
long‑term stability without failure. A study has reported that
Rely‑X Unicem cement has a low expansion which can bear
for long time stability.[16]
Radiopacity of Rely‑X Unicem Self‑Adhesive cement is
important for dentists to diagnose decay and to notice
open gingival margins at the cervical of the tooth as well as
determining the existence of a gap between tooth and cement.
It is significant that adhesive cements have greater radiopacity
than dentin, due to the fact that it is hard to discover a cement
line radiographically when the material is not significantly more
radiopaque than dentin. In some situations where the margin
is set in a difficult access area, of which the marginal fit is less
than perfect, optimal radiopacity helps to ensure complete
removal of excess material. The testing of Rely‑X Unicem
Self‑Adhesive Cement has shown that the radiopacity is the
same as human enamel.[17]
Bonding agents may cause local reactions in dentists and
dental assistants, who, therefore, must protect themselves
from critical materials by wearing gloves and immediately
replacing them in case of contamination. Furthermore, they
have to use volume evacuation where the materials are being
used. All bottles must be conserved closed, or unit dose
systems must be used. Patients should also be protected
while bonding operations.[4] In a study that evaluated the
cytotoxic effect of Rely‑X Unicem on pulp it was found that
with Rely‑X Unicem the survival rate of pulp cells on dentin
slices of 200 µm is almost 80%. On dentin slices of 500 µm, the
survival rate is about 95%. With Rely‑X Unicem, occurrences
of postoperative sensitivity are close to nothing. Out of
4829 independently monitored cases, only 5 (0.1%) showed
short‑term sensitivity. Compared with other materials,
the overall conclusion is that Rely‑X Unicem has a good
biocompatibility (3M ESPE November, 2003).[16]
The mechanical properties are important in terms of adhesive
cement that can stand for a long time without fractures.
Rely‑X Unicem self‑adhesive cement has superb mechanical
properties and establishes increased retentive competency.
In a study by Attar et al. it was reported that according to
ISO standard 4049 Rely‑X Unicem has a high flexural strength
and high modulus of elasticity.[17]
Self‑adhesive cements like Rely‑X Unicem have brought the
bonding process of, for example, orthodontic brackets, back
to a one‑step procedure. Many other applications have also
been simplified as a result of recently developed self‑adhesive
cements. Due to a range of desirable properties, Rely‑X Unicem
has become a popular dental material in many dental procedures.
Among these properties are a high compressive strength,
although not as strong as resin cements, a relatively high flexural
strength and durability in terms of adhesion and strength.[12]
6
[Downloaded free from http://www.dmrjournal.org on Thursday, January 22, 2015, IP: 41.254.8.33]  ||  Click here to download free Android application for this journal
Zidan, et al.: Rely-X unicem
When used in operative and prosthodontic applications
without the etching of enamel, Rely‑X Unicem has shown
contradictory results. Another study showed that Rely‑X
Unicem’s and Panavia F’s tensile strength bond was only
similar when the tooth surface was acid‑etched before Rely‑X
Unicem was applied.[12]
The available data on Rely‑X Unicem use as an orthodontic
bracket adhesive is quite minimal. In one study it was shown
that after storing the teeth for 24 h at 37°C, the shear bond
strength produced by Rely‑X Unicem in orthodontic bracket
bonding was significantly lower than in the cements that
used three‑step acid‑etch procedures. Despite this, Rely‑X
Unicem’s shear bond strength was still acceptable for use as
an orthodontic bracket adhesive.[12]
In an experiment, Rely‑X Unicem showed a significantly
lower µ Tensile Bond Shear  (TBS) to enamel than the
control cement, Panavia F. No difference was observed in
dentin bonding. When applied on acid‑etched enamel,
Rely‑X Unicem’s µTBS significantly increased to a
level comparable to that of Panavia F when bonded
to  (nonetched) enamel. When applied on acid‑etched
dentin, the acid‑etching significantly lowered Rely‑X
Unicem’s µTBS and Panavia F showed a significantly higher
µTBS than Rely‑X Unicem.[13]
In vitro studies have been performed on Rely‑X Unicem on
its properties of adhesion to restorative materials, marginal
adaptation, and microleakage.[18,19] In comparison with Rely‑X
unicem, Hattar et al. have reported that the highest strength
was observed for SmartCem2 (14.18 Mpa).[20]
Rely‑X Unicem did not have a significant decrease of
mechanical stability after thermal loading. The hydrophilic
nature and water sorption due to low‑pH values in the final
cured cements leads to a higher decrease in flexural strength
in most self‑adhesive cements.[21]
CONCLUSION
Most of the internal and independent data suggest that Rely‑X
Unicem has better characteristics for dispensing, handling
and overall ease of use with clinical excellence and reliability.
It had reduced the incidence of microleakage and very low
debonding rates in various dental applications.
Dentistry and Medical Research| Jan-Jun 2015 | Vol 3 | Issue 1
REFERENCES
1. Hikita K, Van Meerbeek B, De Munck J, Ikeda T, Van Landuyt K,
Maida T, et al. Bonding effectiveness of adhesive luting agents to
enamel and dentin. Dent Mater 2007;23:71‑80.
2. Tay FR, Pashley DH, Suh BI, Carvalho RM, Itthagarun A. Single‑step
adhesives are permeable membranes. J Dent 2002;30:371‑82.
3. Popp S. The first truly universal luting material. Espertise 2003;1:8.
4. Powers JM, Sakaguchi RL. Restorative Dental Materials. 12th ed. St.
Louis: Elsevier; 2006.
5. Jones SE. The story of adhesion and developments in dentistry. Int J
Adh Adhes 1995;15:109‑13.
6. Cehreli ZC, Kecik D, Kocadereli I. Effect of self‑etching primer and
adhesive formulations on the shear bond strength of orthodontic
brackets. Am J Orthod Dentofacial Orthop 2005;127:573‑9.
7. Anusavice  KJ. Phillip’s Science of Dental Material. 11th  ed. USA:
Elsevier; 2003.
 8. O’Brien  WJ. Dental Materials and Their Selection. 2nd  ed. Chicago:
Quintessence; 1997.
9. Hatrick  CD, Eakle  SW, Bird  WF. Dental Materials: Clinical
Applications for Dental Assistants and Dental Hygienists. St. Louis:
Elsevier; 2003.
10. Nicholson JW. Adhesive dental materials and their durability. Int J
Adh Adhes 2000;20:11‑6.
11. 3M ESPE. Rely X Unicem Aplicap/Maxicap Self‑Adhesive Universal
Resin cement, Technical Product Profile. 2002.
12. Bishara SE, Ostby AW, Ajlouni R, Laffoon JF, Warren JJ. Early shear
bond strength of a one‑step self‑adhesive on orthodontic brackets.
J Orthod Dentofacial Orthop 2005;76:689‑93.
13. De Munck J, Vargas M, Van Landuyt K, Hikita K, Lambrechts P, Van
Meerbeek B. Bonding of an auto‑adhesive luting material to enamel
and dentin. Dent Mater 2004;20:963‑71.
14. Piwowarczyk A, Lauer  HC, Sorensen  JA. Microleakage of various
cementing agents for full cast crowns. Dent Mater 2005;21:445‑53.
15. Behr  M, Rosentritt  M, Regnet  T, Lang  R, Handel  G. Marginal
adaptation in dentin of a self‑adhesive universal resin cement
compared with well‑tried systems. Dent Mater 2004;20:191‑7.
16. 3M ESPE RelyX Unicem Self‑Adhesive Cement. In vivo clinical
studies, in vitro research, reviews. (January 2002‑March 2004).
17. Attar N, Tam LE, McComb D. Mechanical and physical properties of
contemporary dental luting agents. J Prosthet Dent 2003;89:127‑34.
18. Mörmann W, Wolf D, Ender A, Bindl A, Göhring T, Attin T. Effect
of two self‑adhesive cements on marginal adaptation and strength
of esthetic ceramic CAD/CAM molar crowns. J  Prosthodont
2009;18:403‑10.
19. Aschenbrenner CM, Lang R, Handel G, Behr M. Analysis of marginal
adaptation and sealing to enamel and dentin of four self‑adhesive
resin cements. Clin Oral Investig 2012;16:191‑200.
20. Hattar  S, Hatamleh  M, Khraisat  A, Al‑Rabab’ah M. Shear bond
strength of self‑adhesive resin cements to base metal alloy. J Prosthet
Dent 2014;111:411‑5.
21. Zorzin  J, Petschelt  A, Ebert  J, Lohbauer  U. pH neutralization and
influence on mechanical strength in self‑adhesive resin luting agents.
Dent Mater 2012;28:672‑9.
How to cite this article: Zidan S, Peeran SW, Ramalingam K.
Rely-X unicem self-adhesive universal resin cement. Dent Med
Res 2015;3:3-7.
Source of Support: Nil, Conflict of Interest: Nil.
7