Objectives: Both resin-modified glass ionomer cement (RMGIC) and self-adhesive resin cement (SAC) may be suitable for cementation of full-coverage zirconia restorations. This retrospective study aimed to investigate the clinical outcomes of zirconia-based restorations cemented with RMGIC and compare them with those cemented with SAC.

Methods: Cases of full-coverage zirconia-based restorations cemented with either RMGIC or SAC between March 2016 and February 2019 were evaluated in this study. The clinical outcomes of the restorations were analyzed according to the type of cement used. In addition, cumulative success and survival rates were evaluated according to the cement and abutment types. Non-inferiority, Kaplan-Meier, and Cox hazard tests were conducted (α=.05).

Results: A total of 288 full-coverage zirconia-based restorations (natural teeth, 157; implant restorations, 131) were analyzed. Loss of retention occurred in only one case; a single-unit implant crown cemented with RMGIC, which decemented 4.25 years post-restoration. RMGIC was non-inferior to SAC in terms of loss of retention (<5%). For single-unit natural tooth restorations, the four-year success rates in the RMGIC and SAC groups were 100% and 95.65%, respectively (p=.122). For single-unit implant restorations, the four-year success rates in the RMGIC and SAC groups were 95.66% and 100%, respectively (p=.365). The hazard ratios of all the predictor variables, including cement type, were not significant (p>.05).

Conclusions: Cementation of full-coverage zirconia restorations of both natural teeth and implants using RMGIC and SAC yields satisfactory clinical outcomes. Furthermore, RMGIC is non-inferior to SAC in terms of cementation success.

Clinical significance: Cementation with RMGIC or SAC for full-coverage zirconia restorations has favorable clinical outcomes in both natural teeth and implants. Both RMGIC and SAC have advantages in the cementation of full-coverage zirconia restorations to abutments with favorable geometries.