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Int Poster J Dent Oral Med 15 (2013), No. 1     15. Mar. 2013

Int Poster J Dent Oral Med 2013, Vol 15 No 1, Poster 637

Adhesive cementation protocol of Zirconia restorations

Language: English
 

Authors:
Dr. Ana Petre,
Oral Rehabilitation Department, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
Dr. Ruxandra Sfeatcu,
Oral Health Department, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania

Date/Event/Venue:
April 28th - May 1st 2011
16th Congress of the Balkan Stomatological Society
Bucharest, Romania
 

Introduction

Continuous evolution of dental materials has determined the development of some new and modern manufacturing and cementing techniques for indirect restorations. Due to the relatively recent entry of zirconia and alumina based ceramics in Romanian Dental Practice, there is a lack of information about adhesive cementation technique or, more accurate, about the special preparation of zirconia and alumina surface in order to use an adhesive cementation.
 

Objectives

Our aim is to acquaint practitioners with particular structure of zirconium oxide and microscopic interaction with resin cement in adhesive cementation.
 

Material and Methods

In Romanian dental laboratories are currently used some of the many available brands of zirconia such: ZirCAD (Ivoclar Vivadent), Cercon®Zirconia (Dentsply), Zirox (Wieland), Procera Crown Zirconia (Nobel Biocare), Ceramill (Amann Girrbach), Lava (3M), inCoris (Sirona) and inVizion (Vita). We have studied the indications provided by each manufacturer regarding to preparation of the zirconia surface for the adhesive cementation.
 

Results

All 8 manufactures (Table 1) indicate to sand blast the inner surface of zirconia restoration with Al2O3 particles, 50-110 μm sizes, at different pressure (1-2,8 bar). Furthermore they indicate to use a primer or adhesive cement with MPD monomer. The only exception is 3M Espe which provide one product for silicatisation, Rocatec®Plus, silica-coated Al2O3 110 µm particles, in order to improve the bonding between a non-MDP resin cement like Relyx ARC® and zirconia surface.
 

Zirconia Sand blasting Presure Silicatisation Silanisation Adhesive Cement
self/adhesive
IPS ZirCAD1
Ivoclar
Al2O3 1 bar NO Monobond Plus®
Ivoclar
Variolinkv II (Ivoclar)
Multilink® (Ivoclar)
SpeedCEM® (Ivoclar)
Cercon2
Dentsply
50 50µm Al2O3 2-3 bar NO Prime&Bond NT®
(Dentsply)
Calibra Esthetic Resin Cement®
(Dentsply)
Zirox
Wieland
Al2O3 1 bar NO ED Primer A,B®
(Kuraray)
RelyX Unicem®
(3M Espe)
Panavia® F2.0
(Kuraray)
Procera Zirconia2
Nobel Biocare
max. 100 µmAl2O3 2.5 bar NO Alloy Primer®
(Kuraray)
Panavia® 21TC
(Kuraray)
RelyX Unicem®
(3M Espe)
Ceramill4
Amann Girrbach
110 µm Al2O3 1 bar NO Monobond Plus®
(Ivoclar)
Multilink®
(Ivoclar)
Lava5
3M Espe
Al2O3 + SiO2 ≥ 2.8 bar YES Espe Sil®
(3M Espe)
RelyX&tm; ARC®
(3MEspe)*
NO NO RelyX unicem®
(3M Espe)
inCoris6
Sirona
50 µm Al2O3 ≤ 2.5 bar NO NO Panavia® F2.0
(Kuraray)
Panavia® 21TC
(Kuraray)
inVizion7
Vita
max. 50 µm Al2O3 2.5 bar NO NO Panavia® F2.0
(Kuraray9
Panavia® 21TC
(Kuraray)
Table 1: Manufacturer's indications for adhesive cementation [*non MDP Adhesive Cement]

Conclusions

Zirconia ceramic is a glass-free polycrystalline microstructure, with high fracture strength and fracture toughness, but in the same time an acid-resistant or non-etchable material. This fact determines a lack of adhesion for resin cements. For this reason, there have been some efforts of manufacturers and researchers to modify the surface properties of zirconia by using various methods.

The most used two methods are:
1.) The first method, is the usage of a ceramic primer or resin cement, which contains a bio-functional monomer, 10- methacryloyloxydecyl-dihydrogenphosphate (MDP) (fig. 1). The acidic phosphate groups of this monomer have the property to combine directly with metal oxides 8 as ZrO2, Al2O3, etc. (fig. 2). In vitro studies have proved that the presence of MDP monomer only in primer provide lower bond strength then the usage of both MDP primer and MDP resin cement 9. In addition, different studies, demonstrate that a combination between MDP monomer and a silane-coupling agent on silica-coated zirconia restoration could be a promising method for improving bond strength of resin cements 10.
2.) The second method called "silicatisation", is usually applied in dental laboratories and it is represented by an airborne particle abrasion using 50-110 µm Al2O3 coated with silica (fig. 3). Because of the very high speed of these particles, about 1000km/h11, they are embedded on the Zirconia, resulting the chemically silica-modified surface 12. Furthermore this surface is acting like an usual glass ceramic material and resin cement bonds to it via silane agent (fig. 4).

Fig. 1: MDP monomer - chemical structure Fig. 2a: Successive layers between dentin and zirconia surface in MDP cementation/silicatisation
Fig. 2b: Successive layers between dentin and zirconia surface in MDP cementation/silicatisation
 
Fig. 3: Silicatisation process

Literature

  1. www.ivoclarvivadent.com;IPS e.max® System Ivoclar Vivadent Tehnical;43
  2. www.dentasply.com; Cercon Zirconia Clinic Recomandations;1
  3. Michael Hummel, Matthias Kern; Durability of the resin bond strength to the alumina ceramic Procera; Dental Materials (2004) 20, 498-508
  4. www.wieland-dental.com; Supplement to the Zirox® Instructions for Use (dated 07/05);5
  5. http://solutions.3m.com; All-ceramic System; Tehnical product profile Lava;13
  6. www.sirona.com; Sirona Dental Systems GmbH; Processing instructions inCoris ZI;7
  7. www.vident.com; inVizion Preparation and Cementation;© Vident 2008;
  8. Moustafa N. Aboushelib, Mona Ghoniem, Hesam Mirmohammadi, Ziad Salameh4,General principles for achieving adequate bond to allceramic Restorations, Journal of Dentistry and Oral Hygiene Vol. 1(3), September, 2009;036-041
  9. T. T. Heikkinen,J. P.Matinlinna,P. K. Vallittu, L. V. J. Lassila, Effect of Primers and Resins on the Shear Bond Strength of Resin Composite to Zirconia, SRX Dentistry, Volume 2010,6
  10. R. Tanaka, A. Fujishima, Y. Shibata, A. Manabe and T. Miyazaki,Cooperation of Phosphate Monomer and Silica Modification on Zirconia, J DENT RES 2008 87: 666
  11. http://solutions.3m.com; Rocatec Bonding, Scientific Product Profile;5
  12. Mutlu ÖZCAN, Henk NIJHUIS, Luiz Felipe VALANDRO, Effect of Various Surface Conditioning Methods on the Adhesion of Dual-cure Resin Cement with MDP Functional Monomer to Zirconia after Thermal Aging, Dental Materials Journal 27(1) ,2008: 99-104
     

This Poster was submitted by Dr. Ana Petre.
 

Correspondence address:
Dr. Ana Petre
University of Medicine and Pharmacy Carol Davila
Oral Rehabilitation Department
31, Anton Pann Str.
Bucharest
Romania