Zinc oxide eugenol (ZOE) has been a cornerstone material in dentistry for over a century due to its sedative properties, ease of manipulation, and low cost.
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This article critically reviews the composition, clinical applications, disadvantages, and current alternatives to ZOE, providing an evidence-based perspective on its role in modern dentistry.
✅ Composition of Zinc Oxide Eugenol
ZOE is formed through an acid–base reaction between zinc oxide powder and eugenol liquid.
▪️ Powder: Zinc oxide (ZnO), often with additives such as zinc acetate to accelerate setting
▪️ Liquid: Eugenol (a phenolic compound derived from clove oil)
The setting reaction produces zinc eugenolate, which is responsible for the material’s physical properties and biological effects.
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Despite reduced popularity, ZOE continues to be used in selected clinical situations:
▪️ Temporary restorative material
▪️ Temporary luting cement
▪️ Base or liner under non-resin restorations
▪️ Root canal sealer (traditional formulations)
▪️ Periodontal surgical dressings
▪️ Intermediate restorative material (IRM derivatives)
Its sedative effect on the dental pulp has historically made it attractive in deep cavities and emergency treatments.
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Although biologically soothing, ZOE presents significant drawbacks that limit its use in modern dentistry:
▪️ Interference with resin polymerization, making it incompatible with adhesive restorations
▪️ Low mechanical strength, unsuitable for long-term restorations
▪️ High solubility in oral fluids, leading to marginal leakage
▪️ Potential cytotoxicity of eugenol at high concentrations
▪️ Limited adhesion to tooth structure
These limitations have driven the development and adoption of alternative materials.
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Modern dentistry increasingly favors materials with improved biocompatibility, adhesion, and mechanical performance, including:
▪️ Calcium hydroxide–based liners
▪️ Glass ionomer cements (GIC)
▪️ Resin-modified glass ionomers (RMGIC)
▪️ Calcium silicate–based materials (e.g., MTA, Biodentine)
▪️ Resin-based temporary and permanent materials
These materials offer superior sealing ability, compatibility with adhesive systems, and enhanced longevity.
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ZOE remains a material of historical and limited clinical relevance rather than a first-line option. While it still has niche applications—particularly in temporary procedures or specific endodontic uses—its incompatibility with resin-based materials significantly restricts its role in modern restorative dentistry.
Current trends emphasize bioactive, adhesive, and mechanically stable materials, which better align with minimally invasive and long-term treatment philosophies.
🎯 Clinical Recommendations
▪️ Avoid ZOE under resin-based restorations
▪️ Consider modern bioactive materials for pulp protection
▪️ Use ZOE only for short-term or specific indications
▪️ Evaluate patient needs, restoration type, and material compatibility
▪️ Stay updated with evidence-based material selection guidelines
✍️ Conclusion
Zinc oxide eugenol is still used in dentistry, but its role is increasingly limited. While it offers sedative and antimicrobial benefits, its mechanical weakness and incompatibility with adhesive systems have led to its replacement by more advanced materials. Contemporary dental practice favors alternatives that provide superior durability, biocompatibility, and clinical performance.
📊 Comparative Table: Zinc Oxide Eugenol and Its Modern Alternatives
| Material Type | Clinical Indications | Main Limitations |
|---|---|---|
| Zinc Oxide Eugenol | Temporary restorations, sedative base | Inhibits resin polymerization, low strength |
| Glass Ionomer Cement | Base, liner, temporary and permanent restorations | Lower fracture resistance than composites |
| Resin-Modified GIC | Adhesive base and liner | Moisture sensitivity during placement |
| Calcium Silicate Materials | Pulp capping and dentin regeneration | Higher cost and longer setting time |
✔ Anusavice, K. J., Shen, C., & Rawls, H. R. (2013). Phillips’ science of dental materials (12th ed.). Elsevier.
✔ American Dental Association. (2022). Dental materials guidance and compatibility considerations. Journal of the American Dental Association, 153(4), 345–352. https://doi.org/10.1016/j.adaj.2021.11.012
✔ Hargreaves, K. M., & Berman, L. H. (2020). Cohen’s pathways of the pulp (12th ed.). Elsevier.
✔ Sidhu, S. K., & Nicholson, J. W. (2016). A review of glass-ionomer cements for clinical dentistry. Journal of Functional Biomaterials, 7(3), 16. https://doi.org/10.3390/jfb7030016
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