Surface Treatments for Zirconia Bonding: A Clinical Perspective
Surface Treatments for Zirconia Bonding: A Clinical Perspective Surface Treatments for Zirconia Bonding: A Clinical Perspective
SURFACE TREATMENTS FOR ZIRCONIA BONDING: A CLINICAL PERSPECTIVEFigure 9. Pep Gen granular and flow graft materialswere placed and a collagen membrane sutured inplace for stabilization.Figure 10. Conservative preparation designs withminimal reduction, rounded shoulders, and seatinggrooves parallel in nature.Figure 11. Zirconia framework overlayed withCeram porcelain.Figure 12. Our reputation is built on adhesion.Figure 13. Ten-second application of Z-PRIMEPLUS, which would be followed by air-drying.Figure 14. Maxillary anterior view of restoration.bond zirconia to the tooth substrate. Ourimproved knowledge of non-glass-basedoxides such as zirconia has resulted in thesubsequent innovation of adhesives withspecial qualities. Z-PRIME PLUS is one ofthose special primers that have been shownto significantly increase bond strengths tozirconia allowing for more conservativeremoval of tooth tissue.Treatment CompletionFollowing verification of the fit, the bridgewas cleaned in an ethyl alcohol ultrasonicbath for 10 minutes. Two drops of zirconiaprimer (Z-PRIME) were placed on theinternal surface of the porcelain abutmentsand dried after 10 seconds (Figure 13). It wasmy decision to optimize adhesion with theuse of total etch on dentin/enamel, coupledwith the use of a hydrophobic dual-cure resincement.The abutments were cleaned with slurry ofpumice/water. The etch-and-rinse techniquewas accomplished using phosphoric acid(UNI-ETCH BAC, Bisco) followed bydisinfecting/rewetting with a cavity cleanserCHX and an application of All Bond 3primer/resin. DuoLink dual-cure resincement was placed directly on the teeth, andthe bridge was positioned with moderatedigital pressure. Clean-up was initiallyaccomplished using a microbrush and 2 × 2cotton gauze. Margins were initially lightcured;then the dual cure was allowed tocement to complete polymerization in selfcuremode. Final clean-up was accomplishedusing 204S scaler and explorer. Occlusion waschecked, cuspid disclusion verified, andanterior guidance was checked.Teeth #13 and #21 were prepared lightly usinga finishing diamond to remove old fillingmaterial, to make an irregular finish line, andto remove staining. The teeth were isolatedwith retractors (SeeMore, Discus Dental,Culver City, CA) and etched for 20 secondswith 37% phosphoric acid (UNI-ETCHBAC); subsequently, they were rinsed, andseveral coats of bonding agent (All Bond 3)were applied. Various layers of dentin,enamel, and incisal opacities of composite(Renamel, Cosmedent, Chicago, IL) wereapplied with Creative Color (Cosmedent)stain.The lingual and bulk of the tip on #13 werecompleted using Renamel UniversalFigure 15. A smile to be proud of.Microhybrid for strength, tinted with greyand honey yellow Creative Color and coveredfacially with Renamel Microfil IncisalMedium for polishability. Occlusion waschecked and cuspid disclusion on #6 wasconfirmed. Polishing was completed withFlexiDisk rubber polishers (Cosmedent).Tooth #21 was restored using RenamelMicrofil Incisal Medium, coupled withmatching tints. Shaping was completed withSofLex disks (3M) and polishing withFlexiDisk (Cosmedent) rubber polishers.A clear, vacuum-formed, 2 mm hard/softnocturnal bruxism splint was made(Erkodent, Glidewell Labs, Newport Beach,CA), and the patient was encouraged to wear28 Journal canadien de dentisterie restauratrice et de prosthodontie Hiver 2010
GRIFFIN ET AL.it nightly to prevent parafunctional forcesparticularly under times of stress.The final result was pleasing (Figures 14 and 15).ConclusionPatients demand esthetics. The incorporationof zirconia in clinical dentistry offers a newalternative to metal-free esthetic dentistry.New esthetic restorative materials demandadhesion. Recreating the DEJ is a function ofaddressing the needs of the individualsubstrates involved (enamel, dentin, andindirect materials such as zirconia). The useof adhesives on the tooth substrate and theuse of primers on the indirect substrate inconjunction with quality resin-based cementsare crucial in optimizing clinical outcomes tothese new restorative materials.DisclosureDr. Byoung Suh is the founder of BiscoDental. Dr. Liang Chen is a senior researcherat Bisco Dental. Dr. Douglas Brown is seniormanager of clinical affairs at Bisco Dental.Dr. Jack Griffin Jr. declares he has no financialinterest in the materials mentioned in thisarticle and is not receiving an honorarium forhis contribution to this article. The contentprovided is based solely on his belief intranslating science to the application ofclinical dentistry.References1. Conrad HJ, Seong WJ, Pesun IJ. Currentceramic materials and systems withclinical recommendations: a systematicreview. J Prosthet Dent2007;98(5):389–404.2. Denry I, Kelly JR. State of the art ofzirconia for dental applications. DentMater 2008;24(3):299–307.3. Kelly JR, DenryI. Stabilized zirconia as astructural ceramic: an overview. DentMater 2008;24(3):289–98.4. Aboushelib MN, Kleverlaan CJ, FeilzerAJ. Microtensile bond strength ofdifferent components of core veneeredall-ceramic restorations. Part II: Zirconiaveneering ceramics. Dent Mater2006;22(9):857–63.5. Blatz MB. Long-term clinical success ofall-ceramic posterior restorations.Quintessence Int 2002;33(6):415–26.6. Lopes GC, Baratieri LN, Caldeira deAndrada MA, Maia HP. All-ceramic postcore, and crown: technique and casereport. J Esthet Restor Dent2001;13(5):285–95.7. Meyenberg KH, Luthy H, Scharer P.Zirconia posts: a new all-ceramic conceptfor nonvital abutment teeth. J EsthetDent 1995;7(2):73–80.8. Piconi C, Maccauro G. Zirconia as aceramic biomaterial. Biomaterials1999;20(1):1–25.9. Blatz MB, Sadan A, Kern M. Resinceramicbonding: a review of theliterature. J Prosthet Dent2003;89(3):268–74.10. Borges GA, Sophr AM, de Goes MF, et al.Effect of etching and airborne particleabrasion on the microstructure ofdifferent dental ceramics. J Prosthet Dent2003;89(5):479–88.11. Della Bona A, Anusavice KJ, Shen C.Microtensile strength of compositebonded to hot-pressed ceramics. J AdhesDent 2000;2(4):305–13.12. Derand P, Derand T. Bond strength ofluting cements to zirconium oxideceramics. Int J Prosthodont2000;13(2):131–5.13. Guazzato M, Proos K, Quach L, SwainMV. Strength, reliability and mode offracture of bilayered porcelain/zirconia(Y-TZP) dental ceramics. Biomaterials2004;25(20):5045–52.14. Ozcan M, Vallittu PK. Effect of surfaceconditioning methods on the bondstrength of luting cement to ceramics.Dent Mater 2003;19(8):725–31.15. Janda R, Roulet JF, Wulf M, Tiller HJ. Anew adhesive technology for allceramics.Dent Mater 2003;19(6):567–73.16. Ruttermann S, Fries L, Raab WH, JandaR. The effect of different bondingtechniques on ceramic/ resin shear bondstrength. J Adhes Dent 2008;10(3):197–203.17. Amaral R, Ozcan M, Valandro LF, et al.Effect of conditioning methods on themicrotensile bond strength of phosphatemonomer-based cement on zirconiaceramic in dry and aged conditions. JBiomed Mater Res B Appl Biomater2008;85(1):1–9.18. Ozcan M, Nijhuis H, Valandro LF. Effectof various surface conditioning methodson the adhesion of dual-cure resincement with MDP functional monomerto zirconia after thermal aging. DentMater J 2008;27(1):99–104.19. Tanaka R, Fujishima A, Shibata Y, et al.Cooperation of phosphate monomerand silica modification on zirconia. JDent Res 2008;87(7):666–70.20. Wegner SM, Kern M. Long-term resinbond strength to zirconia ceramic. JAdhes Dent 2000;2(2):139–47.21. Aboushelib MN, Matinlinna JP, SalamehZ, Ounsi H. Innovations in bonding tozirconia-based materials: Part I. DentMater 2008;24(9):1268–72.22. Yoshida K, Tsuo Y, Atsuta M. Bonding ofdual-cured resin cement to zirconiaceramic using phosphate acid estermonomer and zirconate coupler. JBiomed Mater Res B Appl Biomater2006;77(1):28–33.23. Kern M, Barloi A, Yang B. Surfaceconditioning influences zirconia ceramicbonding. J Dent Res 2009;88(9):817–22.24. Ernst CP, Cohnen U, Stender E,Willershausen B. In vitro retentivestrength of zirconium oxide ceramiccrowns using different luting agents. JProsthet Dent 2005;93(6):551–8.25. Marchan S, Coldero L, Whiting R,Barclay S. In vitro evaluation of theretention of zirconia-based ceramic postsluted with glass ionomer and resincements. Braz Dent J 2005;16(3):213–7.26. Uo M, Sjögren G, Sundh A, et al. Effectof surface condition of dental zirconiaceramic (Denzir) on bonding. DentMater J 2006;25(3):626–31.27. Gernhardt CR, Bekes K, Schaller HG.Short-term retentive values of zirconiumoxide posts cemented with glass ionomerand resin cement: an in vitro study and acase report. Quintessence Int2005;36(8):593–601Winter 2010 Canadian Journal of Restorative Dentistry and Prosthodontics 29
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SURFACE TREATMENTS FOR ZIRCONIA BONDING: A CLINICAL PERSPECTIVEFigure 9. Pep Gen granular and flow graft materialswere placed and a collagen membrane sutured inplace <strong>for</strong> stabilization.Figure 10. Conservative preparation designs withminimal reduction, rounded shoulders, and seatinggrooves parallel in nature.Figure 11. <strong>Zirconia</strong> framework overlayed withCeram porcelain.Figure 12. Our reputation is built on adhesion.Figure 13. Ten-second application of Z-PRIMEPLUS, which would be followed by air-drying.Figure 14. Maxillary anterior view of restoration.bond zirconia to the tooth substrate. Ourimproved knowledge of non-glass-basedoxides such as zirconia has resulted in thesubsequent innovation of adhesives withspecial qualities. Z-PRIME PLUS is one ofthose special primers that have been shownto significantly increase bond strengths tozirconia allowing <strong>for</strong> more conservativeremoval of tooth tissue.Treatment CompletionFollowing verification of the fit, the bridgewas cleaned in an ethyl alcohol ultrasonicbath <strong>for</strong> 10 minutes. Two drops of zirconiaprimer (Z-PRIME) were placed on theinternal surface of the porcelain abutmentsand dried after 10 seconds (Figure 13). It wasmy decision to optimize adhesion with theuse of total etch on dentin/enamel, coupledwith the use of a hydrophobic dual-cure resincement.The abutments were cleaned with slurry ofpumice/water. The etch-and-rinse techniquewas accomplished using phosphoric acid(UNI-ETCH BAC, Bisco) followed bydisinfecting/rewetting with a cavity cleanserCHX and an application of All Bond 3primer/resin. DuoLink dual-cure resincement was placed directly on the teeth, andthe bridge was positioned with moderatedigital pressure. Clean-up was initiallyaccomplished using a microbrush and 2 × 2cotton gauze. Margins were initially lightcured;then the dual cure was allowed tocement to complete polymerization in selfcuremode. Final clean-up was accomplishedusing 204S scaler and explorer. Occlusion waschecked, cuspid disclusion verified, andanterior guidance was checked.Teeth #13 and #21 were prepared lightly usinga finishing diamond to remove old fillingmaterial, to make an irregular finish line, andto remove staining. The teeth were isolatedwith retractors (SeeMore, Discus Dental,Culver City, CA) and etched <strong>for</strong> 20 secondswith 37% phosphoric acid (UNI-ETCHBAC); subsequently, they were rinsed, andseveral coats of bonding agent (All Bond 3)were applied. Various layers of dentin,enamel, and incisal opacities of composite(Renamel, Cosmedent, Chicago, IL) wereapplied with Creative Color (Cosmedent)stain.The lingual and bulk of the tip on #13 werecompleted using Renamel UniversalFigure 15. A smile to be proud of.Microhybrid <strong>for</strong> strength, tinted with greyand honey yellow Creative Color and coveredfacially with Renamel Microfil IncisalMedium <strong>for</strong> polishability. Occlusion waschecked and cuspid disclusion on #6 wasconfirmed. Polishing was completed withFlexiDisk rubber polishers (Cosmedent).Tooth #21 was restored using RenamelMicrofil Incisal Medium, coupled withmatching tints. Shaping was completed withSofLex disks (3M) and polishing withFlexiDisk (Cosmedent) rubber polishers.A clear, vacuum-<strong>for</strong>med, 2 mm hard/softnocturnal bruxism splint was made(Erkodent, Glidewell Labs, Newport Beach,CA), and the patient was encouraged to wear28 Journal canadien de dentisterie restauratrice et de prosthodontie Hiver 2010
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