Adhesion to Zirconia Used for Dental Restorations: A Systematic Review and Meta-Analysis Mutlu Özcana / Mira Bernasconib

Purpose: Currently, no consensus exists regarding the best adhesion protocol for zirconia used in dentistry; this is important particularly for restorations where mechanical retention is deficient. This systematic review analyzed the adhesion potential of resin-based and glass-ionomer luting cements to zirconia and aimed to highlight the possible dominant factors affecting the bond strength results to this substrate. Materials and Methods: Original scientific papers on adhesion to zirconia published in the MEDLINE (PubMed) database between 01/01/1995 and 01/06/2011 were included in this systematic review. The following MeSH terms, search terms, and their combinations were used: “Dental bonding”, “Zirconium”, “Zirconia”, “Y-TZP”, “Y-TZP ceramic”, “Materials Testing/methods”, “Test”, “Cement”, and “Resin bonding”. Two reviewers performed screening and data abstraction. Descriptive statistics were performed and the frequencies of the studied parameters, means, standard deviations, confidence intervals (95% CI; uncorrected and corrected), median values, and interquartile ranges (IQR) were calculated for the bond strength data reported for different factor levels: surface conditioning methods (control, physicochemical, physical, chemical), cements (bis-GMA-, MDP-, and 4-META-based resin cements, self-adhesive cements, glass ionomer), aging with and without thermocycling (TC), and test methods (macroshear, microshear, macrotensile, and microtensile). Results: The final search provided 177 titles with abstracts. Further abstract screening yielded 72 articles, out of which 54 were found potentially appropriate to be included. After full text evaluation, 2 of these were eliminated. The selection process resulted in the final sample of 52 studies. In total, 169 different surface conditioning methods, mainly combinations of air-abrasion protocols and adhesive promoters (primers or silanes), were investigated. Altogether, the use of 5 types of cements and 4 testing methods was reported. While 26 studies were performed without TC as aging, 26 of them employed thermocycling at varying number of cycles. This review highlighted that adhesion of the luting cements is significantly influenced by the surface conditioning method (p = 0.044), cement type (p = 0.018), test method (p = 0.017) and aging condition (p = 0.003). In nonconditioned control groups without thermocycling, mean bond strength values ranged between 1.15 (IQR = 3.54) and 8.93 (IQR = 9), and 6.9 (IQR = 0) and 8.73 (IQR = 13.93) MPa for macroshear and macrotensile tests, respectively. After physical conditioning method, MDP monomer based cement presented the highest bond values compared to those of other resin cements using either the macrotensile (no TC: 34.2; IQR = 24.18 MPa, TC: 42.35; IQR = 0 MPa) or microtensile (no TC: 37.2; IQR = 41.5 MPa, TC: 17.1; IQR = 31.15 MPa) test method. Conclusion: Based on the results of this systematic review, increased adhesion could be expected after physicochemical conditioning of zirconia. MDP-based resin cements tend to present higher results than those of other cements types when tested using macro- and microtensile tests. Adhesion studies on zirconia and reporting of data require more standardization. Keywords: adhesion, bond strength, dental cements, meta-analysis, surface conditioning, systematic review, test methods, zirconia. J Adhes Dent 2015; 17: 7–26. doi: 10.3290/j.jad.a33525

Submitted for publication: 26.12.12; accepted for publication: 21.01.15

a

Professor, Clinic for Fixed and Removable Prosthodontics and Dental Materials Science, Center for Dental and Oral Medicine, University of Zurich, Zurich, Switzerland. Designed the study, performed the experiments, analyzed the data, wrote the manuscript, discussed the results and commented on the manuscript at all stages.

*Part of this study was presented at the 89th General Session and Exhibition of the International Association for Dental Research (IADR), March 16-19th, 2011, San Diego, California, USA.

b

Master’s Student, Clinic for Fixed and Removable Prosthodontics and Dental Materials Science, Center for Dental and Oral Medicine, University of Zurich, Zurich, Switzerland. Performed the experiments, analyzed the data, prepared the draft of the manuscript, discussed the results and commented on the manuscript at all stages.

Correspondence: Professor Mutlu Özcan, University of Zurich, Dental Materials Unit, Center for Dental and Oral Medicine, Clinic for Fixed and Removable Prosthodontics and Dental Materials Science, Plattenstrasse 11, CH-8032, Zurich, Switzerland. Tel: +41-44-634-5600; Fax: +41-44-634-4305. e-mail: [email protected]

Vol 17, No 1, 2015

7

Özcan / Bernasconi

Y

ttrium-stabilized zirconia offers a wide variety of clinical applications, such as fixed dental prostheses (FDPs), root posts, or implant abutments in reconstructive dentistry. It has the most favorable mechanical properties compared to other high-strength ceramics with flexural strengths of 900 to 1200 MPa, fracture resistance of more than 2000 N and fracture toughness of 9 to 10 MPa m 0.5 that is almost twice the value obtained for alumina-reinforced ceramics and almost three times the value demonstrated by lithiumdisilicate–based ceramics. 28,29,84 The cementation process of a resin-bonded FDP is the final step of operative treatment after a series of procedures in dentistry. Due to the advances in adhesion promoters, at present, bonded restorations constitute an integral part of minimal invasive dentistry. In that respect, not only the strength of the restoration but also the adhesion of cements both to the dental tissues and to the particular restorative material is of importance for the long-term clinical success. This aspect becomes even more important when retention of FDPs does not rely on macromechanical principles as in the case of resin-bonded FDPs or cantilever restorations. Etching the cementation surface with hydrofluoric acid (HF) and subsequent silanization of the silica-based ceramics is a well-established method to achieve durable adhesion of resin-based materials.15 Silane coupling agents promote adhesion between the inorganic phase of the ceramic and the organic phase of the bonding agent through siloxane bonds.46 In addition, silane increases the surface energy of ceramic substrates and improves cement wettability.66 This approach makes it possible today to adhere minimally invasive restorations to dental tissues. Unfortunately, neither etching with acidic solutions nor applying silane coupling agents has resulted in adequate resin bond to high-alumina34,35,42,44,58 or zirconia ceramics13,35,44,58 since these substrates do not contain a silicon dioxide (silica) phase. For this reason, in order to enhance the bond strength of luting cements to oxidebased ceramics, numerous surface conditioning methods have been suggested during the last two decades. While some of these methods facilitate resin-ceramic bonding micromechanically (physically) employing air-borne particle abrasion with alumina particles,6,13,22,24,34 others are based on physicochemical activation of the ceramic surfaces using silica-coated alumina particles followed by silanization,34,58,61,65,72,74,79,83,87 or chemical activation with functional-monomer–containing adhesive promoters or resin cements.35,83 In addition to these, flame treatment/silane deposition,32 selective infiltration etching26 of the surface, and the use of cements containing the phosphate ester monomer 10-methacryloyloxydecyl dihydrogenphosphate (MDP) are among other proposed methods.83 Durable adhesion of bis-GMA–based resin cement to zirconia ceramics was not achieved using some of these in vitro methods.36,52,61 Moreover, not the chemistry alone but the roughness created by air abrasion was thought to be the main bonding mechanism for MDP monomers.2 Recent alternative methods such as the selective infiltration etching technique and the 8

use of MDP monomers have also been combined with novel reactive silane monomers, giving initial high bond strengths.2,46 Since concerns exist on the possible damage created by the air-abrasion methods,88 some manufacturers have started to promote primers or resin cements based on organophosphate/carboxylic acid monomers specific for zirconia, which could eliminate aggressive conditioning methods.40 However, hydrolytic degradation of silanes, primers, or such acidic monomers is still problematic.1,18,30 Hydrolysis of silanes and primers in water diminishes the performance of silane and thus limits the lifetime of adhesive joints.30 Furthermore, methods of aging the adhesive joints between the resin-based materials and zirconia vary from short- and long-term water storage to thermocycling at diverse temperatures, dwell time, and number of cycles. All these factors make it difficult to compare different studies on the same materials even when the same test method was employed. Several testing methodologies such as shear, tensile, and microtensile tests have been suggested for evaluation of the bond strength of resin-based materials to dental ceramics. These test methods are based on the application of load in order to generate stress at the adhesive joints until failure occurs. Consequently, for the test to accurately measure the bond strength values between an adherent and a substrate, it is crucial that the bonding interface should be the most stressed region, regardless of the test method employed.17,18 Limited information is available on the adhesion of resin materials to zirconia where different test methods are compared in one study.81 Since the adhesive joints are subjected to both shear and tensile forces during chewing, all test methods are currently being used, depending on the research hypothesis to be tested. Thus, the use of only one type of test method could not be proposed. Testing parameters in in vitro studies on adhesion to zirconia show great variation; consequently, there is still no consensus on the best adhesion protocol to zirconia. This lack of consensus creates confusion in the dental community as to which cement should be used in combination with which conditioning method for the cementation of zirconia FDPs. The test parameters vary considerably among the available published studies. Hence, there is an apparent need to develop methodological guidelines for testing and interpreting the data on adhesion to zirconia. The objectives of this systematic review were therefore to analyze the adhesion potential of resin-based adhesive and glass-ionomer luting cements to zirconia and to highlight the possible dominant factors affecting the bond strength results to this ceramic.

MATERIALS AND METHODS Search Strategy Before the initiation of the literature search, a protocol to be followed was agreed upon by the authors. An electronic search in MEDLINE (PubMed) (http://www. ncbi.nlm.nih.gov/entrez/query.fcgi) from 01/01/1995 The Journal of Adhesive Dentistry

Özcan / Bernasconi

up to and including 01/06/2011 was conducted for English-language articles published in the dental literature, using the following MeSH terms, search terms, and their combinations: “Dental bonding”, “Zirconium”, “Zirconia”, “Y-TZP”, “Y-TZP ceramic”, “Materials Testing/methods”, “Test”, “Cement”, “Resin bonding”. The MEDLINE search yielded 174 references to be screened for possible inclusion based on titles and abstracts (Table 1). A further manual search covering the period from 01/01/1995 up to and including 01/06/2011 was performed on the following journals: Journal of Dental Research, Dental Materials, Journal of Adhesive Dentistry, International Journal of Prosthodontics, Journal of Prosthetic Dentistry, Journal of Prosthodontics, and Journal of Biomedical Materials Research Part B: Applied Biomaterials. An additional 3 references were obtained after further manual searching. Inclusion/Exclusion Criteria In vitro studies reporting on adhesion to zirconia alone or to other ceramics using microtensile, macrotensile, microshear or macroshear were included. Publications were excluded if zirconia was adhered onto tooth substance, data were not presented in MPa, and number of specimens was less than 5 in the subgroups. Also, studies performed with pull-out test were not included. Studies that employed surface conditioning methods using adhesion promoters such as adhesive resins, silane coupling agents or primers only were grouped under “chemical” and those that used only air-abrasion protocols, abrasives, or etchants were categorized as “physical”. When both physical and chemical conditioning methods were applied, those groups were classified as “physicochemical”. “Control” groups were defined as zirconia substrates ground with silicone carbide papers only. Selection of Studies Two independent reviewers (M.B. and M.Ö.) screened the 177 titles retrieved from the electronic and handsearched articles for possible inclusion in the review. After initial elimination, based on the titles and the abstracts, 72 abstracts were accepted for inclusion by both reviewers. After discussion, a consensus was reached to include 54 articles. Full-text articles of the 54 selected publications were obtained. In addition, manual searches were performed on bibliographies of the selected articles as well as identified narrative reviews to determine whether the search process had missed any relevant article. This did not result in new additional articles to be involved in the review process. The two reviewers independently assessed the 54 fulltext articles to determine whether they fulfilled the defined criteria for final inclusion. Any disagreement was resolved by discussion. Fifty-two studies were found to qualify for inclusion in the review, while two studies had to be excluded after reading the full text. The process of identifying the studies included in the review from an initial 177 titles is presented in Fig 1.

Vol 17, No 1, 2015

Table 1 Search strategy in MEDLINE applied for this review Search

Literature search strategy

Results

1

“Dental Bonding” [MeSH]

17009

2

“Zirconium” [MeSH]

3585

3

“Zirconia” [MeSH]

0

4

“Zirconia”

1907

5

“y-tzp”

169

6

“y-tzp ceramic”

31

7

(“1995/01/01”[Publication Date] : “2011/06/01” ”[Publication Date]) AND ((((((#1) AND #2) OR #3) OR #4) OR #5) OR #6)

2088

8

“Materials Testing/methods” [MeSH]

4049

9

Test

2851288

10

((#7) AND #8) OR #9

2851311

11

((#7) AND #8)

43

12

((#7) AND #9)

656

13

Cement

35035

14

Resin bonding

9398

15

((#12) AND #13) AND #14)

174

#: search; MeSH: medical subjects heading, a thesaurus word.

Data Extraction The two reviewers used a data extraction form previously agreed upon to extract the data independently. A data collection form containing 26 items was created and used to assess the experimental conditions that may possibly have affected the bond strength. Two studies were rejected at subsequent stages and the reasons for exclusion were recorded. Disagreement regarding data extraction was resolved by discussion and consensus. The variables were recorded and tabulated in Excel sheets. Studies in which data on a certain variable were lacking or could not be calculated were entered as “not reported” for the variable in question. Statistical Analysis Statistical analyses were performed using the Statistical Package for the Social Sciences (version 18.0, SPSS; Chicago, IL, USA). With respect to the reporting of experimental conditions of the included abstracts before the consensus meeting, the interobserver agreement is expressed as weighted Cohen’s kappa. As descriptive statistics, the means and standard deviations, or medians and interquartile ranges in skewed distributions were noted. The frequencies of the studied parameters were calculated. Weighted mean values and the 95% confidence interval (CI) for the various outcomes were calcu9

Özcan / Bernasconi

Potentially relevant studies according to initial electronic search (n = 174) Independent screening by 2 reviewers Kappa score: 0.87 Studies included after hand search (n = 3) Studies retrieved for abstract evaluation (n = 71) Studies excluded after abstract reading (n = 18) Potentially appropriate to be included in the study (n = 54) Studies excluded after full-text reading (n = 2) Studies included for the final analysis (n = 52)

Fig 1 Process of identifying the studies included in the review.

Table 2

lated. Confidence intervals (95% CI, both uncorrected and corrected) were calculated for mean bond strength for different factor levels: surface conditioning methods (control, physicochemical, physical, chemical), cements (bis-GMA–, MDP-, 4-META–based resin cements, self-adhesive cements, glass ionomer), aging (with and without thermocycling), and test methods (macroshear, microshear, macrotensile, microtensile). P-values less than 0.05 were considered to be statistically significant in all comparisons. Bond strength variability by the material, test method, conditioning method, and cement type was calculated. Data were transformed and computations for the percentage of parameter impact were completed using Ln tables. The meta-regression approach was used where the contribution of each study was weighed by its standard deviation.

RESULTS Characteristics of the Included/Excluded Studies The publications qualified for inclusion are presented in Table 2. The Kappa score for interexaminer agreement on screening abstracts was 0.87. In the selected 52 articles,2-8,10-12,14,22-24,31-33,36,38,40, 42,44,46-50,51-56,58,60-63,66,67,69,71,73-75,75,78,79,81,83,84,87

a total of 609 experimental subgroups were identified where bond strength results were reported in MPa. In all selected subgroups, the search identified great variety of surface conditioning protocols with 169 different methods to condition zirconia surfaces prior to cement adhesion (Table 3). Of the selected 52 articles, 38 articles did not contain a control group with no con-

Articles selected for the review that met the inclusion criteria

Number

Sources listed chronologically

1

Kern M, Wegner SM. Bonding to zirconia ceramic: adhesion methods and their durability. Dent Mater 1998;14:64-71.

2

Derand P, Derand T. Bond strength of luting cements to zirconium oxide ceramics. Int J Prosthodont 2000;13:131-135.

3

Wegner SM, Kern M. Long-term resin bond strength to zirconia ceramic. J Adhes Dent 2000;2:139-147.

4

Janda R, Roulet JF, Wulf M, Tiller HJ. A new adhesive technology for all-ceramics. Dent Mater 2003;19:567-573.

5

Özcan M, Vallittu PK. Effect of surface conditioning methods on the bond strength of luting cement to ceramics. Dent Mater 2003;19:725-731.

6

Blatz MB, Sadan A, Martin J, Lang B. In vitro evaluation of shear bond strengths of resin to densely-sintered high-purity zirconium-oxide ceramic after long-term storage and thermal cycling. J Prosthet Dent 2004;91:356-362.

7

Bottino MA, Valandro LF, Scotti R, Buso L. Effect of surface treatments on the resin bond to zirconium-based ceramic. Int J Prosthodont 2005;18:60-65.

8

Derand T, Molin M, Kvam K. Bond strength of composite luting cement to zirconia ceramic surfaces. Dent Mater 2005;21:1158-1162.

9

Amaral R, Özcan M, Bottino MA, Valandro LF. Microtensile bond strength of a resin cement to glass infiltrated zirconia-reinforced ceramic: the effect of surface conditioning. Dent Mater 2006;22:283-290.

10

Atsu SS, Kilicarslan MA, Kucukesmen HC, Aka PS. Effect of zirconium-oxide ceramic surface treatments on the bond strength to adhesive resin. J Prosthet Dent 2006;95:430-436.

10

The Journal of Adhesive Dentistry

Özcan / Bernasconi 11

Lüthy H, Loeffel O, Hämmerle CH. Effect of thermocycling on bond strength of luting cements to zirconia ceramic. Dent Mater 2006;22:195-200.

12

Matinlinna JP, Heikkinen T, Özcan M, Lassila LV, Vallittu PK. Evaluation of resin adhesion to zirconia ceramic using some organosilanes. Dent Mater 2006;22:824-831.

13

Tsuo Y, Yoshida K, Atsuta M. Effects of alumina-blasting and adhesive primers on bonding between resin luting agent and zirconia ceramics. Dent Mater J 2006;25:669-674.

14

Uo M, Sjögren G, Sundh A, Goto M, Watari F, Bergman M. Effect of surface condition of dental zirconia ceramic (Denzir) on bonding. Dent Mater J 2006;25:626-631.

15

Valandro LF, Özcan M, Bottino MC, Bottino MA, Scotti R, Bona AD. Bond strength of a resin cement to high-alumina and zirconia-reinforced ceramics: the effect of surface conditioning. J Adhes Dent 2006;8:175-181.

16

Aboushelib MN, Kleverlaan CJ, Feilzer AJ. Selective infiltration-etching technique for a strong and durable bond of resin cements to zirconia-based materials. J Prosthet Dent 2007;98:379-388.

17

Blatz MB, Chiche G, Holst S, Sadan A. Influence of surface treatment and simulated aging on bond strengths of luting agents to zirconia. Quintessence Int 2007;38:745-753.

18

Matinlinna JP, Lassila LV, Vallittu PK. Pilot evaluation of resin composite cement adhesion to zirconia using a novel silane system. Acta Odontol Scand 2007;65:44-51.

19

Quaas AC, Yang B, Kern M. Panavia F 2.0 bonding to contaminated zirconia ceramic after different cleaning procedures. Dent Mater 2007;23:506-512.

20

Wolfart M, Lehmann F, Wolfart S, Kern M. Durability of the resin bond strength to zirconia ceramic after using different surface conditioning methods. Dent Mater 2007;23:45-50.

21

Lohbauer U, Zipperle M, Rischka K. Hydroxylation of dental zirconia surfaces: Characterization and bonding potential. J Biomed Mater Res B Appl Biomater 2008;87:461-467.

22

Nishigawa G, Maruo Y, Irie M, Oka M, Yoshihara K, Minagi S, Nagaoka N, Yoshida Y, Suzuki K. Ultrasonic cleaning of silicacoated zirconia influences bond strength between zirconia and resin luting material. Dent Mater J 2008;27:842-848.

23

Özcan M, Nijhuis H, Valandro LF. Effect of various surface conditioning methods on the adhesion of dual-cure resin cement with MDP functional monomer to zirconia after thermal aging. Dent Mater J 2008;27:99-104.

24

Özcan M, Kerkdijk S, Valandro LF. Comparison of resin cement adhesion to Y-TZP ceramic following manufacturers’ instructions of the cements only. Clin Oral Investig 2008;12:279-282.

25

Re D, Augusti D, Sailer I, Spreafico D, Cerutti A. The effect of surface treatment on the adhesion of resin cements to Y-TZP. Eur J Esthet Dent 2008;3:186-196.

26

Spohr AM, Borges GA, Júnior LH, Mota EG, Oshima HM. Surface modification of In-Ceram zirconia ceramic by Nd:YAG laser, Rocatec system, or aluminum oxide sandblasting and its bond strength to a resin cement. Photomed Laser Surg 2008;26:203-208.

27

Valandro F, Özcan M, Amaral R, Vanderlei A, Bottino MA. Effect of testing methods on the bond strength of resin to zirconiaalumina ceramic: microtensile versus shear test. Dent Mater J 2008;27:849-855.

28

Komine F, Kobayashi K, Saito A. Shear bond strength between an indirect composite veneering material and zirconia ceramics after thermocycling. J Oral Sci 2009;51:629-634.

29

Nothdurft FP, Motter PJ, Pospiech PR. Effect of surface treatment on the initial bond strength of different luting cements to zirconium oxide ceramic. Clin Oral Investig 2009;13:229-235.

30

Oyagüe RC, Monticelli F, Toledano M, Osorio E, Ferrari M, Osorio R. Effect of water aging on microtensile bond strength of dual-cured resin cements to pre-treated sintered zirconium-oxide ceramics. Dent Mater 2009;25:392-399.

31

Oyagüe RC, Monticelli F, Toledano M, Osorio E, Ferrari M, Osorio R. Influence of surface treatments and resin cement selection on bonding to densely-sintered zirconium-oxide ceramic. Dent Mater 2009;25:172-179.

32

Aboushelib MN, Feilzer AJ, Kleverlaan CJ. Bonding to zirconia using a new surface treatment. J Prosthodont 2010;19:340-346.

33

Akyil MS, Uzun IH, Bayindir F. Bond strength of resin cement to yttrium-stabilized tetragonal zirconia ceramic treated with air abrasion, silica coating, and laser irradiation. Photomed Laser Surg 2010;28:801-808.

34

Blatz MB, Phark JH, Ozer F, Mante FK, Saleh N, Bergler M, Sadan A. In vitro comparative bond strength of contemporary selfadhesive resin cements to zirconium oxide ceramic with and without air-particle abrasion. Clin Oral Investig 2010;14: 187-192.

35

Jevnikar P, Krnel K, Kocjan A, Funduk N, Kosmac T. The effect of nano-structured alumina coating on resin-bond strength to zirconia ceramics. Dent Mater 2010;26:688-696.

Vol 17, No 1, 2015

11

Özcan / Bernasconi

Table 2

(cont.) Articles selected for the review that met the inclusion criteria

Number

Sources listed chronologically

36

Magne P, Paranhos MP, Burnett LH Jr. New zirconia primer improves bond strength of resin-based cements. Dent Mater 2010;26:345-352.

37

May LG, Passos SP, Capelli DB, Özcan M, Bottino MA, Valandro LF. Effect of silica coating combined to a MDP-based primer on the resin bond to Y-TZP ceramic. J Biomed Mater Res B Appl Biomater 2010;95:69-74.

38

Mirmohammadi H, Aboushelib MN, Salameh Z, Feilzer AJ, Kleverlaan CJ. Innovations in bonding to zirconia based ceramics: Part III. Phosphate monomer resin cements. Dent Mater 2010;26:786-792.

39

Mirmohammadi H, Aboushelib MN, Salameh Z, Kleverlaan CJ, Feilzer AJ. Influence of enzymatic and chemical degradation on zirconia resin bond strength after different surface treatments. Am J Dent 2010;23:327-330.

40

Ntala P, Chen X, Niggli J, Cattell M. Development and testing of multi-phase glazes for adhesive bonding to zirconia substrates. J Dent 2010;38:773-781.

41

Passos SP, May LG, Barca DC, Özcan M, Bottino MA, Valandro LF. Adhesive quality of self-adhesive and conventional adhesive resin cement to Y-TZP ceramic before and after aging conditions. Oper Dent 2010;35:689-696.

42

Takeuchi K, Fujishima A, Manabe A, Kuriyama S, Hotta Y, Tamaki Y, Miyazaki T. Combination treatment of tribochemical treatment and phosphoric acid ester monomer of zirconia ceramics enhances the bonding durability of resin-based luting cements. Dent Mater J 2010;29:316-323.

43

Ural C, Kulunk T, Kulunk S, Kurt M, Baba S. Determination of resin bond strength to zirconia ceramic surface using differ36ent primers. Acta Odontol Scand 2010;69:48-53.

44

Ural Ç, Külünk T, Külünk Ġ, Kurt M. The effect of laser treatment on bonding between zirconia ceramic surface and resin cement. Acta Odontol Scand 2010;68:354-359.

45

Yun JY, Ha SR, Lee JB, Kim SH. Effect of sandblasting and various metal primers on the shear bond strength of resin cement to Y-TZP ceramic. Dent Mater 2010;26:650-658.

46

Zhang W, Masumi SI, Song XM. Bonding property of two resin-reinforced glass-ionomer cements to zirconia ceramic. Quintessence Int 2010;41:132-140.

47

Attia A, Lehmann F, Kern M. Influence of surface conditioning and cleaning methods on resin bonding to zirconia ceramic. Dent Mater 2011;27:207-213.

48

Behr M, Proff P, Kolbeck C, Langrieger S, Kunze J, Handel G, Rosentritt M. The bond strength of the resin-to-zirconia interface using different bonding concepts. J Mech Behav Biomed Mater 2011;4:2-8.

49

Foxton RM, Cavalcanti AN, Nakajima M, Pilecki P, Sherriff M, Melo L, Watson TF. Durability of resin cement bond to aluminium oxide and zirconia ceramics after air abrasion and laser treatment. J Prosthodont 2011;20:84-92.

50

Kuriyama S, Terui Y, Higuchi D, Goto D, Hotta Y, Manabe A, Miyazaki T. Novel fabrication method for zirconia restorations: Bonding strength of machinable ceramic to zirconia with resin cements. Dent Mater J 2011;30:419-424.

51

Monaco C, Cardelli P, Scotti R, Valandro LF. Pilot evaluation of four experimental conditioning treatments to improve the bond strength between resin cement and Y-TZP ceramic. J Prosthodont 2011;20:97-100.

52

Paranhos MP, Burnett LH Jr, Magne P. Effect Of Nd:YAG laser and CO2 laser treatment on the resin bond strength to zirconia ceramic. Quintessence Int 2011;42:79-89.

ditioning. In the other 24 articles, 66 subgroups were identified where control groups were present. All steps of conditioning methods applied on zirconia were listed as described by the authors and then categorized in 4 groups. Physicochemical conditioning methods based on using abrasives or etchants followed by adhesion promoters were practiced in 318, physical conditioning methods using abrasives only were found in 201, and only chemical conditioning methods using adhesive promoters were investigated in 11 subgroups. Similarly, since different luting cements were tested within one study, in these subgroups, the cements used were initially listed and then categorized based on their 12

main chemical compositions given in the articles or taken from the material safety sheet data (Table 4). With respect to their main composition, 5 types of luting cements were identified: bis-GMA (n = 82), MDP (n = 168), 4-META (n = 15), self-adhesive (n = 337) and glass ionomer (n = 7). Mainly methacrylate-based cements that were not self-adhesive cements and did not contain MDP or 4-META in their compositions were classified as bisGMA–based cements. In regard to aging conditions, non-aged and aged groups were initially identified; the type and duration of aging methods were listed. Among the selected 52 articles, bonded specimens were aged by means of thermocycling The Journal of Adhesive Dentistry

Özcan / Bernasconi

Table 3

Surface conditioning methods used for zirconia according to sequence stated by the authors

Surface conditioning method No treatment Sandblasting 50-μm Al2O3 + ultrasonic cleaning in isopropyl alcohol 3 min Sandblasting 100-μm Al2O3 + ultrasonic cleaning in isopropyl alcohol 3 min RocatecPrePowder + RocatecPlultrasonic + ultrasonic cleaning in isopropyl alcohol 3 min + silanization Sandblasting 110-μm Al2O3 + ultrasonic cleaning in isopropyl alcohol 3 min Sandblasting 110-μm Al2O3 + ultrasonic cleaning in isopropyl alcohol 3 min + silanization Sandblasting 110-μm Al2O3 + ultrasonic cleaning in isopropyl alcohol 3 min + RocatecPrePowder + RocatecPlultrasonic + silanization Sandblasting 110-μm Al2O3 + ultrasonic cleaning in isopropyl alcohol 3 min + Kevloc oven method Grinding 800 grit + PyrosilPen 5 s + silanization Grinding 800 grit + PyrosilPen 10 s + silanization Grinding 800 grit + PyrosilPen 20 s + silanization Grinding 1200 grit + ultrasonic cleaning in ethylacetate 10 min + etching + silanization Grinding 1200 grit + ultrasonic cleaning in ethylacetate 10 min + RocatecPrePowder + RocatecPlultrasonic + silanization Grinding 1200 grit + ultrasonic cleaning in ethylacetate 10 min + sandblasting 110-μm Al2O3 + silanization Grinding 1200 grit + ultrasonic cleaning in distilled water 3 min + sandblasting 110-μm Al2O3 + silanization Grinding 1200 grit + ultrasonic cleaning in distilled water 3 min + RocatecPrePowder + RocatecPlultrasonic + silanization Grinding 1200 grit + ultrasonic cleaning in distilled water 3 min + CoJet + silanization Grinding 1200 grit + sandblasting 50-μm Al2O3 + ultrasonic cleaning in distilled water 5 min Grinding 1200 grit + RocatecPrePowder + RocatecPlultrasonic + silanization Grinding 1200 grit + RocatecPrePowder + RocatecPlultrasonic + ultrasonic cleaning in distilled water 1 min + silanization Grinding 1200 grit + RocatecPrePowder + RocatecPlultrasonic + ultrasonic cleaning in distilled water 5 min + silanization Sandblasting 125-μm Al2O3 Tribochemical silica coating 50-μm (Supradental) Sandblasting 50-μm Al2O3+ ultrasonic cleaning in isopropyl alcohol 3 min + silanization Grinding 40-μm + ultrasonic cleaning in ethylacetate 5 min + sandblasting 110-μm Al2O3 Grinding 40-μm + ultrasonic cleaning in ethylacetate 5 min + sandblasting 110-μm Al2O3 + RocatecPrePowder + RocatecPlultrasonic Grinding 40-μm + ultrasonic cleaning in ethylacetate 5 min + sandblasting 110-μm Al2O3 + RocatecPrePowder + RocatecPlultrasonic + silanization Grinding 1200 grit + sandblasting 50-μm Al2O3 + silanization Grinding 1200 grit + sandblasting 50-μm Al2O3 + RocatecPrePowder + RocatecPlultrasonic + silanization Grinding 1200 grit + sandblasting 50-μm Al2O3 + Nd:YAG laser irradiation + silanization Grinding 1200 grit + sandblasting 110-μm Al2O3 Grinding 1200 grit + sandblasting 110-μm Al2O3 + RocatecPrePowder + RocatecPlultrasonic + silanization Grinding 1200 grit + sandblasting 110-μm Al2O3 + CoJet + silanization Grinding 1200 grit + ultrasonic cleaning in distilled water 3 min + sandblasting 50-μm Al2O3 + AlloyPrimer Grinding 1200 grit + ultrasonic cleaning in distilled water 3 min + sandblasting 50-μm Al2O3 + Cesead II Opaque Primer Grinding 1200 grit + ultrasonic cleaning in distilled water 3 min + sandblasting 50-μm Al2O3 + SilanoPen 5 s + silanization Grinding 800 grit + sandblasting 110-μm Al2O3 + HIM/SIE Grinding 800 grit + sandblasting 110-μm Al2O3 Grinding 1200 grit + ultrasonic cleaning in distilled water 3 min + sandblasting 50-μm Al2O3 Grinding 1200 grit + ultrasonic cleaning in distilled water 3 min + silanization Grinding 1200 grit + ultrasonic cleaning in distilled water 3 min ultrasonic cleaning in isopropyl alcohol 3 min ultrasonic cleaning in isopropyl alcohol 3 min + sandblasting 50-μm Al2O3 ultrasonic cleaning in isopropyl alcohol 3 min + Rocatec Soft + silanization

Surface conditioning method Vol 17, No 1, 2015

13

Özcan / Bernasconi

Table 3

(cont.) Surface conditioning methods used for zirconia according to sequence stated by the authors 

Grinding 600 grit + ultrasonic cleaning in isopropyl alcohol 3 min Sandblasting 110-μm Al2O3 + ultrasonic cleaning in isopropyl alcohol 3 min + silanization Sandblasting 110-μm Al2O3 + ultrasonic cleaning in isopropyl alcohol 3 min + RocatecPrePowder + RocatecPlultrasonic +ultrasonic cleaning in isopropyl 3min + silanization Sandblasting 50-μm Al2O3 + ultrasonic cleaning in ethanol 10 min + RocatecPlultrasonic + ultrasonic cleaning in ethanol 10 min + silanization Sandblasting 70-μm Al2O3 Sandblasting 125-μm SiC Sandblasting 125-μm SiC + etching Sandblasting 125-μm SiC + etching + silanization RocatecPre Powder + RocatecPlultrasonic + silanization Sandblasting 250-μm Al2O3 + silanization Sandblasting 50-μm Al2O3 + silanization Sandblasting 50-μm Al2O3 + etching + silanization Grinding + silanization Grinding 600 grit + sandblasting 50-μm Al2O3+ saliva contamination + waterspray + sandblasting 50-μm Al2O3 Grinding 600 grit + sandblasting 50-μm Al2O3+ saliva contamination + waterspray + sandblasting 50-μm Al2O3 + etching + waterspray Grinding 600 grit + sandblasting 50-μm Al2O3+ saliva contamination + waterspray + sandblasting 50-μm Al2O3 + 2x etching + waterspray Grinding 600 grit + sandblasting 50-μm Al2O3+ saliva contamination + waterspray + sandblasting 50-μm Al2O3 + Cleaning in isopropanol 15 s + waterspray Grinding 600 grit + sandblasting 50-μm Al2O3+ saliva contamination + waterspray + sandblasting 50-μm Al2O3+ waterspray Grinding 1200 grit + ultrasonic cleaning in ethanol 10 min + sandblasting 110-μm Al2O3+ silanization Grinding 1200 grit + ultrasonic cleaning in ethanol 10min + CoJet + silanization Sandblasting 125-μm Al2O3+ ultrasonic cleaning in isopropyl alcohol 3 min Sandblasting 125-μm Al2O3+ ultrasonic cleaning in isopropyl alcohol 3 min + silanization Sandblasting 125-μm Al2O3+ ultrasonic cleaning in isopropyl alcohol 3 min + silanization + bonding Sandblasting 125-μm Al2O3+ ultrasonic cleaning in isopropyl alcohol 3 min + CoJet Sandblasting 125-μm Al2O3+ ultrasonic cleaning in isopropyl alcohol 3 min + CoJet + silanization Sandblasting 125-μm Al2O3+ ultrasonic cleaning in isopropyl alcohol 3 min + CoJet + silanization + bonding ultrasonic cleaning in isopropyl alcohol 3 min + Heliobond Cleaning with air-powder-water spray (sodium hydrocarbonate solution) + ultrasonic cleaning in isopropyl alcohol 3 min + Heliobond Sandblasting 50-μm Al2O3 + ultrasonic cleaning in isopropyl alcohol 3 min + Heliobond Sandblasting 110-μm Al2O3 + ultrasonic cleaning in ethanol 10 min + RocatecPlultrasonic + ultrasonic cleaning in ethanol 10 min + silanization Grinding 600 grit + sandblasting 110-μm Al2O3+ RocatecPrePowder + RocatecPlultrasonic + silanization Grinding 1200 grit + ultrasonic cleaning in ethanol 10 min + RocatecPrePowder + RocatecPlultrasonic + silanization Cleaning with ethanol Cleaning with ethanol + silanization Cleaning with ethanol + RF plasma treatment Cleaning with ethanol + Micro Pearls of low fultrasonicing porcelain Cleaning with ethanol + Micro Pearls of low fultrasonicing porcelain + silanization Grinding 800 grit + etching + silanization Grinding 800 grit + etching + silanization + RocatecPrePowder Grinding 800 grit + etching + silanization + RocatecPrePowder + RocatecPlultrasonic Grinding 800 grit + etching + silanization + RocatecPrePowder + NaOH Grinding 800 grit + etching + silanization + RocatecPrePowder + H3PO4 Grinding 800 grit + etching + silanization + RocatecPrePowder + Piranha (H2SO5) Grinding 800 grit + etching + silanization + RocatecPrePowder + H2C2O4/HCL Grinding 800 grit + etching + silanization + RocatecPrePowder + Piranha (H2SO5) + silanization

14

The Journal of Adhesive Dentistry

Özcan / Bernasconi Grinding 600 grit + ultrasonic cleaning in acetone 10 min + sandblasting 50-μm Al2O3 + ultrasonic cleaning in acetone 10 min + All Bond 2 Primer B Grinding 600 grit + ultrasonic cleaning in acetone 10 min + sandblasting 50-μm Al2O3 + ultrasonic cleaning in acetone 10 min + Alloy Primer Grinding 600 grit + ultrasonic cleaning in aceton 10 min + sandblasting 50-μm Al2O3 + ultrasonic cleaning in acetone 10 min + AZ Primer Grinding 600 grit + ultrasonic cleaning in aceton 10 min + sandblasting 50-μm Al2O3 + ultrasonic cleaning in aceton 10 min + Estenia Opaque Primer Grinding 600 grit + ultrasonic cleaning in acetoen 10 min + sandblasting 50-μm Al2O3 + ultrasonic cleaning in acetone 10 min + Porcelain Liner M Liquid Sandblasting 50-μm Al2O3 Sandblasting 75-μm Al2O3 Sandblasting 100-μm Al2O3 Sandblasting 150-μm Al2O3 Sandblasting 25-μm Al2O3 + Primer ultrasonic cleaning in isopropyl alcohol 3 min + silanization ultrasonic cleaning in isopropyl alcohol 3 min + sandblasting 50-μm Al2O3+ ultrasonic cleaning in isopropyl alcohol 3 min + silanization ultrasonic cleaning in isopropyl alcohol 3 min + Er:YAG laser + ultrasonic cleaning in isopropyl alcohol 3 min + silanization ultrasonic cleaning in ethanol 10 min + silanization ultrasonic cleaning in ethanol 10 min + CoJet + silanization ultrasonic cleaning in ethanol 10 min + sandblasting 50-μm Al2O3 (before sintering) + silanization ultrasonic cleaning in ethanol 10 min + sandblasting 100-μm Al2O3+ silanization ultrasonic cleaning in ethanol 10 min + sandblasting 50-μm Al2O3 (after sintering) + silanization Grinding 1500 grit + sandblasting 50-μm Al2O3+ Nd:YAG + etching (phosphoric acid) + ultrasonic cleaning 2 min + Primer Grinding 1500 grit + CoJet + Nd:YAG + etching (phosphoric acid) + ultrasonic cleaning cleaning 2 min + Primer Grinding 1500 grit + Nd:YAG + etching (phosphoric) + ultrasonic cleaning 2 min + Primer Grinding 1500 grit + sandblasting 50-μm Al2O3+ CO2 laser + etching (phosphoric) + ultrasonic cleaning 2 min + Primer Grinding 1500 grit + CoJet + CO2 laser + etching (phosphoric) + ultrasonic cleaning 2 min + Primer Grinding 1500 grit + CO2 laser + etching (phosph.) + ultrasonic cleaning 2 min + Primer Grinding 1500 grit + sandblasting 50-μm Al2O3+ etching (phosphoric) + ultrasonic cleaning 2 min + Primer Grinding 1500 grit + CoJet + etching (phosphoric) + ultrasonic cleaning 2 min + Primer Grinding 1500 grit + etching (phosphoric) + ultrasonic cleaning 2 min + Primer Grinding 1200 grit + ultrasonic cleaning in isopropyl alcohol 30 s+ ultrasonic cleaning in distilled water 5 min Grinding 1200 grit + CoJet + silanization + ultrasonic cleaning in distilled water 5 min Sandblasting 110-μm Al2O3+ silanization Sandblasting 110-μm Al2O3 + RocatecPlultrasonic + silanization Sandblasting 110-μm Al2O3 Rocatec PrePowder + RocatecPlultrasonic + silanization Rocatec PrePowder + RocatecPlultrasonic + ultrasonic cleaning in isopropyl alcohol 3 min + silanization ultrasonic cleaning in isopropyl alcohol 3 min + sandblasting 110-μm Al2O3+ ultrasonic cleaning in isopropyl alcohol 3 min + silanization ultrasonic cleaning in isopropyl alcohol 3 min + CoJet + silanization ultrasonic cleaning in isopropyl alcohol 3 min + Er:YAG laser + ultrasonic cleaning in isopropyl alcohol 3 min + silanization ultrasonic cleaning in isopropyl alcohol 3 min + Nd:YAG laser + ultrasonic cleaning in isopropyl alcohol 3 min + silanization ultrasonic cleaning in isopropyl alcohol 3 min + CO2 laser + ultrasonic cleaning in isopropyl alcohol 3 min + silanization ultrasonic cleaning in isopropyl alcohol 3 min + sandblasting 110-μm Al2O3 + ultrasonic cleaning in isopropyl alcohol 3 min + Er:YAG laser + ultrasonic cleaning in isopropyl alcohol 3 min + silanization ultrasonic cleaning in isopropyl alcohol 3 min + sandblasting 110-μm Al2O3 + ultrasonic cleaning in isopropyl alcohol 3 min + Nd:YAG laser + ultrasonic cleaning in isopropyl alcohol 3 min + silanization ultrasonic cleaning in isopropyl alcohol 3 min + sandblasting 110-μm Al2O3 + ultrasonic cleaning in isopropyl alcohol 3 min + CO2 laser + ultrasonic cleaning in isopropyl alcohol 3 min + silanization Grinding 600 grit + ultrasonic cleaning in distilled water 3 min + sandblasting 110-μm Al2O3

Vol 17, No 1, 2015

15

Özcan / Bernasconi

Table 3

(cont.) Surface conditioning methods used for zirconia according to sequence stated by the authors 

Surface Conditioning Method Grinding 600 grit + ultrasonic cleaning in distilled water 3 min + sandblasting 110-μm Al2O3 + silanization Grinding 600 grit + ultrasonic cleaning in distilled water 3 min Grinding 600 grit + ultrasonic cleaning in distilled water 3 min + etching (hydrofluoric acid) Grinding 600 grit + ultrasonic cleaning in distilled water 3 min + CO2 laser Grinding 1200 grit + ultrasonic cleaning in distilled water 5 min + etching (phosphoric acid) Grinding 1200 grit + ultrasonic cleaning in distilled water 5 min + silanization Grinding 1200 grit + ultrasonic cleaning in distilled water 5 min + CoJet + silanization Grinding 800 grit + sandblasting 110-μm Al2O3+ ultrasonic cleaning in distilled water 10 min Sandblasting 50-μm Al2O3+ Overglaze1 + silanization Sandblasting 50-μm Al2O3 + Overglaze2 + silanization Sandblasting 50-μm Al2O3 + Overglaze3 + silanization Sandblasting 50-μm Al2O3 + Overglaze4 + silanization Sandblasting 110-μm Al2O3 + ultrasonic cleaning in distilled water 10 min ultrasonic cleaning in ethyl acetone 10 min ultrasonic cleaning in ethyl acetone 10 min + sandblasting 25-μm Al2O3 ultrasonic cleaning in ethyl acetone 10 min + RocatecSoft + silanization ultrasonic cleaning in ethyl acetone 10 min + Primer ultrasonic cleaning in ethyl acetone 10 min + sandblasting 25-μm Al2O3+ Primer ultrasonic cleaning in ethyl acetone 10 min + RocatecSoft + silanization + Primer Grinding 1200 grit + ultrasonic cleaning in distilled water 5min Grinding 1200 grit + ultrasonic cleaning in distilled water 5 min + sandblasting 90-μm Al2O3 Grinding 1200 grit + ultrasonic cleaning in distilled water 5 min + Alloy Primer Grinding 1200 grit + ultrasonic cleaning in distilled water 5 min + sandblasting 90-μm Al2O3+ Alloy Primer Grinding 1200 grit + ultrasonic cleaning in distilled water 5 min + V-Primer Grinding 1200 grit + ultrasonic cleaning in distilled water 5 min + sandblasting 90-μm Al2O3+ V-Primer Grinding 1200 grit + ultrasonic cleaning in distilled water 5 min + Metaltite Grinding 1200 grit + ultrasonic cleaning in distilled water 5 min + sandblasting 90-μm Al2O3+ Metaltite Grinding 4000 grit Grinding 4000 grit + Alumina coating (AIN Powder) Sandblasting 110-μm Al2O3 + Alumina coating (AIN Powder) Alumina coating (AIN Powder) Selective infiltration etching (SIE) Grinding 1500 grit + sandblasting 50-μm Al2O3+ cleaning with phosphoric acid + ultrasonic cleaning in distilled water 2 min Grinding 1500 grit + sandblasting 50-μm Al2O3 + cleaning with phosphoric acid + ultrasonic cleaning in distilled water 2 min + Zirconia Primer Grinding 1500 grit + sandblasting 50-μm Al2O3 + cleaning with phosphoric acid + ultrasonic cleaning in distilled water 2 min + Clearfil Ceramic Primer Sandblasting 120-μm Al2O3 + ultrasonic cleaning in distilled water 10 min

in 26 of them. While in 419 subgroups no thermocycling was practiced, 190 subgroups were thermocycled at varying number of cycles between 500 and 37,500. Other aging or storage conditions showed great diversity, and mainly comprised aging in water, isopropanol, or ethanol. The duration of aging by water storage ranged between 0.16 and 730 days. Either tap water or distilled water was used as the storage medium. Due to the substantial heterogeneity 16

among the reports with respect to water storage conditions, data analysis considered mainly thermocycling. Four testing methods, ie, macrotensile (n = 60), microtensile (n = 117), microshear (n = 30) and macroshear (n = 402), were conducted to evaluate the adhesion of luting cements to zirconia. Table 5 shows descriptive statistics on the different parameters tabulated from the selected studies according The Journal of Adhesive Dentistry

Özcan / Bernasconi

to the surface conditioning method, luting cement type, aging conditions, and the test method considering the Ln mean bond strength in MPa. The major findings based on the cement type are described below.

Table 4 List of luting cements studied, according to their main composition based on material safety sheet data

Bis-GMA–based Cements Mean bond strength using the macroshear test in nonaged conditions showed higher bond strengths after physicochemical conditioning methods (10.1 MPa, IQR = 11.1) than did the control (1.15 MPa, IQR = 3.54), physical (9.7 MPa, IQR = 12.6), and chemical conditioning methods (4.4 MPa, IQR = 0). After thermocycling, physicochemical conditioning methods (9 MPa, IQR = 11.35) again yielded higher bond strengths than those of other conditioning methods (chemical: 1 MPa, IQR = 0, physical: 2.7 MPa, IQR = 0). Thermocycling tends to decrease the bond strengths after physical conditioning. No data were available for the macrotensile test. Bond strength results of bis-GMA cements using the microtensile test were only available in non-aged conditions with results for physicochemical (11.46 MPa, IQR = 10.76) and physical (10.1 MPa, IQR = 11.10) conditioning, and in aged conditions only with physicochemical conditioning (3.6 MPa, 95% CI: 0, 19.1). Microtensile bond strengths in non-aged conditions with physicochemical conditioning were similar to macroshear test results, but after aging, bond strength was lower than with the macroshear test. With the microshear test using bis-GMA–based cements, data were available only without thermocycling. With this test method, physicochemical conditioning (11.46 MPa, IQR = 10.76) presented data similar to those from macroshear (9 MPa, IQR = 11.35) and microtensile tests (11.4 MPa, IQR = 25.25). After all data evaluation, 10 MPa was considered the common denominator (Figs 2a to 2f). With this cement type, after aging and macroshear testing, only physicochemical conditioning methods exceeded this value (Fig 2d).

Quadrant Posterior Dense

Resin type

Product name

bis-GMA

Elite Cement

BisCem Experimental Bis-GMA resin Variolink II Variolink Ultra Bifix QM MDP

Panavia F Panavia F2.0 Panavia EX Panavia 21 EX Panavia 21

Self-adhesive

M Bond Duo-Link ResiCem RelyX U100 RelyX Luting RelyX ARC RelyX Unicem Clearfil Esthetic Cement Permacem Smartmix Multilink Automix Multilink Sprint Multilink Clearfil SA Cement Bistite II DC Maxcem

MDP-based Cements The mean bond strength using the macroshear test in non-aged conditions was higher with this cement after physicochemical conditioning methods (12.31 MPa, IQR = 13.87) than in the control (8.93 MPa, IQR = 9) and with physical conditioning (15 MPa, IQR = 13.27). After thermocycling, physicochemical conditioning methods (16.85 MPa, IQR = 14.17) again showed higher bond strengths, followed by physical conditioning methods (11.58 MPa, IQR = 23.21). Control groups presented decreased bond strength with thermocycling (0.61 MPa, IQR = 2.4) compared to without (8.93 MPa, IQR = 9). No data were available for chemical conditioning methods, either with or without thermocycling. With the macrotensile test without thermocycling, the highest results were obtained in the control group (42.35 MPa, IQR = 0), followed by physical (34.2 MPa, IQR = 24.18) and physicochemical (21.7 MPa, IQR = 10.27) conditioning methods. After thermocycling, data were only available for physical conditioning methods (44.05 MPa, IQR = 0). Vol 17, No 1, 2015

Nexus G-Cem automatrix GC G-Cem capsule GC G-Cem Calibra Duo Cement Plus Paracem Universal DC Dual Cement Twinlook Linkmax HV Estenia C&B Body Opaque Glass ionomer

Dyract Cem Fuji I Fuji Plus Ketac-Cem

4-META

Superbond

17

Özcan / Bernasconi

Table 5 Significant effects of the testing parameters where the dependent variable was mean bond strength (MPa) Tests of between-subject effects Dependent variable: Ln Mean Bond Strength (MPa) Source

Type III sum of squares

df

Mean square

F

Significance

Corrected model

109.710ª

38

2.887

4.109

0.000

Intercept

233.371

1

233.371

332.168

0.000

Thermocycling

1.480

1

1.480

2.107

0.147

Luting cement

8.764

4

2.191

3.119

0.015

Test method

8.330

3

2.777

3.952

0.008

Surface conditioning method

20.528

3

6.843

9.739

0.000

Luting cement x test method

4.519

6

0.753

1.072

0.378

Luting cement x surface conditioning method

13.147

9

1.461

2.079

0.030

Test method x surface conditioning method

15.621

7

2.232

3.176

0.003

Luting cement x test method x surface conditioning method

2.417

5

0.483

0.688

0.633

Error

354.094

504

0.703

Total

3734.016

543

463.805

542

Corrected total aR2

= 0.237 (adjusted

R2

= 0.179).

Cement type: bis–GMA Test methods

n = 24

n=4

n=2

n=4

20 10

n=4

n=2

n=2

0 50

d

e

f

40

TC

30 n = 14

20

n=3

Surface conditioning methods

Chemical

Physical

Physicochemical

Control

Chemical

Physical

Physicochemical

Control

n=1 Physical

n=1

0

Physicochemical

n=2

n=3

Control

10

18

n=2

n=1

Aging

30

c

b

Chemical

Mean bond strength (MPa)

40

Microshear

Microtensile a

no TC

Macroshear 50

Figs 2 (a to f) Mean bond strength (MPa) for bis-GMA based cements after macroshear, microtensile, and microshear tests with (d to f) and without (a to c) thermocycling; n = number of experimental groups involved in statistics.

The Journal of Adhesive Dentistry

Özcan / Bernasconi

Cement type: MDP Test methods

With the microtensile test, data were available only for physicochemical (12.03 MPa, IQR = 17.52 and 9.4 MPa, IQR = 0) and physical conditioning methods (37.2 MPa, IQR = 41.5 and 17.1 MPa, IQR = 31.15) without and with thermocycling, respectively. No data were available for the microshear test with and without thermocycling. When 10 MPa was considered the common denominator (Figs 3a to 3 h) – given this cement type, aging by thermocycling, the macroshear and microtensile tests and physicochemical and physical conditioning – the macrotensile test plus physical conditioning produced values above this (Figs 3e to 3 h). Self-adhesive Cements The mean bond strength using the macroshear test in non-aged conditions was higher with this cement type after physicochemical conditioning methods (34.9 MPa, IQR = 25.6) than that of the control (9.45 MPa, IQR = 8.64) and physical conditioning (18.2 MPa, IQR = 17.16). After thermocycling, all these groups showed decreased values. With the macrotensile test, without thermocycling, the results for control, physicochemical, and physical conditioning ranged between 8.73 MPa, IQR = 13.93 and 11.82 MPa, IQR = 7.79. The microtensile test, without thermocycling, physicochemical (11.68 MPa, IQR = 28.11) and physical (10.8 MPa, IQR = 7.85) conditioning showed higher results Vol 17, No 1, 2015

Microtensile

b

n=8

n = 11

Microshear c

d

no TC

Macrotensile

n=1

n = 13 n=3

n=6

f

n=2

Aging

n=1

h

g

TC

n = 10 n=3

n=1

Chemical

Physical

Physicochemical

Control

Physical

Chemical

Physicochemical

Control

Chemical

Physical

Control

n=1 Physicochemical

Chemical

Physical

Control

Figs 3 (a to h) Mean bond strength (MPa) for MDP-based cements after macroshear, microtensile, and microshear tests with (e to h) and without (a to d) thermocycling; n = number of experimental groups involved in statistics.

Physicochemical

Mean bond strength (MPa)

Macroshear 60 n = 48 a 50 40 n = 26 30 n = 6 20 10 0 60 e * 50 40 n = 15 n = 7 30 20 10 n = 4 0

Surface conditioning methods

than with the macrotensile test. No data were available from the microshear test with or without thermocycling, or from the macrotensile and microtensile test with thermocycling. When 10 MPa was considered the common denominator, with this cement type, after aging, none of the extracted data exceeded this value (Figs 4e to 4 h). 4-META–based Cement Data were available only from the macroshear test and physicochemical conditioning method without (19.9 MPa, IQR = 8.3) and with thermocycling (9.35 MPa, IQR = 31.2) (Fig 5). Glass-ionomer Cement Data could be extracted only from the macroshear test and physical conditioning method without thermocycling (4.7 MPa, IQR = 9.12) (Fig 6). Synopsis of Results In general, significant effects of surface conditioning methods (p = 0.002) and thermocycling (p = 0.007) were observed on the bond strength results (Table 5). Luting cement type (p = 0.064) and test method (p = 0.195) did not significantly affect the results. Interactions between luting cement type and test method were not significant (p = 0.356). Regardless of the conditioning methods, MDP-based cement showed significant differences between non-thermocycled and thermocycled conditions when the mac19

Özcan / Bernasconi

Cement type: Self-adhesive Test methods Macroshear

Microtensile

Macrotensile

a

b

Microshear c

d

20

n = 59 n = 40 n = 13

n=9

n=9

n = 12

n = 11 n = 16

n=1 0 80

e

*

f

n=2

n=4 n=5

Aging

n = 30 40

no TC

60

h

g

60 n = 50 40

n = 17

* n = 17 n = 21

TC

Mean bond strength (MPa)

80

n = 10

20

Physical

Chemical

Physicochemical

Control

Chemical

Physical

Physicochemical

Control

Chemical

Physical

Physicochemical

Control

Chemical

Physical

Physicochemical

Control

0

Figs 4 (a to h) Mean bond strength (MPa) for self-adhesive cements after macroshear, microtensile, microshear tests with (e to h) and without (a to d) thermocycling; n = number of experimental groups involved in statistics.

40

Cement type: Glass-ionomer Test methods Macroshear

20

Aging

10 0

n=4

40 30

10

no TC

20

n=4

15

n=1

5

Aging

no TC

n=9

30

0

20

n=1 n=1

0

10 5

n=1

TC

15

20 10

Mean bond strength (MPa)

Cement type: 4-META Test methods Macroshear

TC

Mean bond strength (MPa)

Surface conditioning methods

n=1

0

Control

Physicochemical

Physical

Physicochemical

Physical

Surface conditioning methods

Surface conditioning methods

Fig 5 Mean bond strength (MPa) for 4-META cements after macroshear test with and without thermocycling; n = number of experimental groups involved in statistics.

Fig 6 Mean bond strength (MPa) for glass-ionomer cements after macroshear test with and without thermocycling; n = number of experimental groups involved in statistics.

roshear (p = 0.032) and macrotensile test (p = 0.003) (Table 6) were used. Likewise, the self-adhesive cement type showed significant differences between non-thermocycled and thermocycled conditions with macroshear test (p = 0.000). Meta-regression by adjusting the data for the influence of thermocycling indicated no significant effect (p = 0.244) in relation to surface conditioning method

(p = 0.633), type of cement (p = 0.582), or test method (p = 0.403). Although it was not the main objective, in order to find the effect of water storage aging on the adhesion results to zirconia, the groups were clustered into storage < 90 days (n = 372) or > 90 days (n = 77). The data were transformed, and Ln tables indicated no significant effect of water storage > 90 days on the bond strength in relation to the cement type (p = 0.519) or

20

The Journal of Adhesive Dentistry

Özcan / Bernasconi

surface conditioning method (p = 0.436), but it did so in relation to the test method (p = 0.019). The mean bond strength in terms of coefficient of variation (CV) for the test method, the surface conditioning method, the cement type, and aging are presented in Table 7. Although cross comparisons were not possible for all groups, both for bis-GMA and MDP cement types tested using the microtensile test, the CV values were higher for physicohemical conditioning methods.

Table 6 Significant effects of test method and aging condition on the adhesion to zirconia by cement type Luting cement

Test method

Aging with thermocycling

p-value

bis-GMA

Macroshear

No TC

0.071

TC

0.055

No TC

0.706

TC

0.607

No TC

0.355

TC

-

No TC

-

TC

-

No TC

0.230

TC

0.032

Microtensile

DISCUSSION Microshear

Especially due to the increased accessibility of CAD/ CAM technologies, zirconia and other oxide-based ceramics have gained popularity. The developments in adhesive dentistry have also increased the indication spectrum of this ceramic for resin-bonded FDPs. Nevertheless, bonding to silica-free oxide ceramics still remains a challenge to the dental community. Hence, a growing number of studies are being published to the end of achieving the best adhesion to zirconia. Since the trials involve various conditioning methods and a variety of adhesive promoters or cements in diverse testing environments, an optimal cementation protocol for zirconia has not yet been established. For this reason, this systematic review was undertaken to evaluate the current status of adhesion of luting cements to zirconia and to make suggestions for future investigations. The primary prerequisite for an effective adhesion of polymeric materials onto any substance is to achieve a clean surface free of contaminants. In the reviewed articles, although the majority of the studies typically involved grinding zirconia specimen surfaces with silicone carbide abrasive papers ranging between 600 and 4000 grit, others started by cleaning the surfaces with various solvents. Those who did not use silicone carbide abrasive papers perhaps did not report this step, which could not be identified in the texts. In fact, surface conditioning already takes place with the grinding process itself. When only chemical conditioning methods are employed, such as silanes or primers, the initial surface roughness may have an impact on the results. Specimens ground/finished with any kind of silicone carbide abrasive papers were considered the control group in terms of surface conditioning. For air-abraded groups, the grinding process may have less importance, since the surface is subsequently more aggressively abraded. Since a plethora of conditioning methods was noted, in this review they were categorized into four groups only. The particle deposition techniques were considered physical conditioning methods. The abrasives used were frequently Al2O3 or SiO2 particles with particle size ranging between 30 and 250 μm. Air-abrasion methods certainly clean the surface and increase the surface energy. However, not only the size of the particles but also the application modes of air-abrasion methods need to be taken into consideration for effective particle deposition.59 In that respect, the pressure and duration of the particle deposition dictate the level of surface roughness. Vol 17, No 1, 2015

Macrotensile

MDP

Macroshear

Microtensile

Microshear

Macrotensile

Self-adhesive

Macroshear

Microtensile

Microshear

Macrotensile

Giass ionomer

Macroshear

Microtensile

Microshear

Macrotensile

4-META

Macroshear

Microtensile

Microshear

Macrotensile

No TC

0.382

TC

0.325

No TC

-

TC

-

No TC

0.003

TC

0.221

No TC

0.082

TC

0.000

No TC

0.890

TC

0.301

No TC

0.008

TC

-

No TC

0.047

TC

-

No TC

0.468

TC

0.317

No TC

-

TC

-

No TC

-

TC

-

No TC

-

TC

-

No TC

-

TC

0.931

No TC

-

TC

-

No TC

-

TC

-

No TC

-

TC

-

21

Özcan / Bernasconi

Table 7 Mean bond strength variation (coefficient of variation) for test method, surface conditioning method, cement type, and aging Luting cement

Test method

Aging with thermocycling

bis-GMA

Macroshear

No TC

Coefficient of variation

Control

1.056

Physicochemical

0.752

Physical

0.751

Chemical

0.288

Luting cement

Test method

Aging with thermocycling

Selfadhesive

Macroshear

No TC

TC

Microtensile

Macroshear

Physical

0.729

1.011

TC

1.222

Control

1.305

Physicochemical

0.79

Physical

1.338

No TC Physicochemical

0.945

Physical

0.566

Microtensile

1.733

No TC

No TC Physicochemical

0.866

Physical

0.672

TC

Physicochemical

0.45

Physicochemical

1.045

Chemical

0.18

Physical

0.936

No TC

Microshear

No TC

Control

0.517

Control

0.881

Physicochemical

0.737

Physicochemical

0.231

Physical

0.518

Physical

0.386

Chemical

0.001

Control

1.316

Physicochemical

0.762

Control

0.883

Physical

0.869

Physicochemical

0.9

Physical

0.49

Macrotensile

No TC Physicochemical

0.836

Physical

0.628

Physicochemical

1.263

Physical

0.771

No TC Control

0.793

Physicochemical

0.244

Physical

0.375

TC Physical

0.299

Nevertheless, the results in general indicated that physicochemical conditioning methods – regardless of such deposition-related parameters – tend to increase the bond strength values for resin-based cements. On the other hand, different air-abrasion regimens have a potential 22

0.701

Physical

Glass ionomer

Macroshear

TC

Macrotensile

Physicochemical

Physicochemical

TC

Microtensile

0.619

0.125

Physicochemical

MDP

Control

Control

TC

Microshear

Coefficient of variation

4-META

Macroshear

No TC

No TC Physical

0.784

No TC

-

Physicochemical

0.469

TC Physicochemical

1.225

effect on grain transformation and further low-temperature degradation of zirconia that has not been clarified yet in dentistry.37,68,86 Since controversial results are present, the use of phosphonic-acid–based silanes or primers, MDP-based cements, or self-adhesive cements that react directly with the oxides present on the zirconia surface are considered good alternatives to air-abrasion systems. However, based on the available data, the results of this review indicated that compared to the control groups where no conditioning was undertaken, physThe Journal of Adhesive Dentistry

Özcan / Bernasconi

ical conditioning with air abrasion seems to increase the bond strength. Thus, also resin cements based on MDP monomer or self-adhesive cements could profit from an initial conditioning. The question remains to be answered whether air-abrasion protocols exert detrimental effects on the fatigue strength of zirconia. The classification of cements into the group of self-adhesive cements considering their chemical compositions was a difficult task in this review. These cements shows great variation in their chemical compositions: while some contain phosphoric acid esters, MDP, bis-HEMA phosphate, glycerolphosphate dimethacrylate, or 4-META, others contain bis-GMA alone or in combination with TEGDMA. Furthermore, the exact percentage of these monomers was also not always available. Subgrouping based on these monomers would have been preferable, but this was also almost impossible for some materials with the information available from manufacturers’ data sheets. Furthemore, although such cements are intended for use without any additional physical or chemical conditioning of the substrate, some of them enclosed a separate ceramic primer containing methacrylate monomers or MDP. Thus, we classified cements as self-adhesive according to their usage and presentation to the dentists on the dental market from the perspective of application. On the other hand, similar to glass-ionomer cements, the 4-META/MMA cement group was classified separately, because these cements are based on a powder-liquid system which differs from all other resin-based cements. In bond strength studies, the bonded joints are subjected to different aging conditions to estimate the longterm clinical behavior. While water storage simulates aging due to water uptake and hydrolytic degradation, thermocycling represents in vitro hydrothermal aging. Temperature changes and the concomitant repetitive contractionexpansion stresses that occur inside the specimen or at the interface as a result of thermocycling are expected to have a significant impact on the bond strength. In the selected studies, the number of water-storage days varied enormously between 0.16 and 730 days. When water storage over 3 months was clustered, only 67 subgroups were identified; this was much fewer compared to the 419 subgroups in the thermocycled group. Moreover, the upper limit of water storage at 730 days created even more scatter in the analyzed data. For this reason, the focus for aging was mainly thermocycling and the comparisons were made intrastudy. Since thermocycling could be considered to represent worse case aging scenario, the data extraction was performed only from non-thermocycled and thermocycled groups. The number of cycles also varied greatly, between 500 and 37,500 cycles. Therefore, the results presented here showed high standard deviations. According to the ISO norm 10477,30 the minimum number of thermocycles was proposed as 5000 to assess metal-resin bonds. Some standardization of the aging protocol appears crucial. In general, thermocycling seems to decrease the bond strength results. The frequency of cycling in vivo remains to be determined at present and requires formal estimation. In the absence of this information, on the asVol 17, No 1, 2015

sumption that such cycles may occur between 20 and 50 times a day, 10,000 cycles are proposed as potentially representative of one year of in vivo functioning.21,25 During the review, it was also noted that when the microtensile test was employed, either the zirconia-cement block or the beams that were obtained after cutting the cement-ceramic block underwent thermocycling. Assuming that the bonded area of the beams was about 1 mm2, a higher aging affect and consequently lower bond strength in the beams could be expected. In this meta-analysis, although it was not the main objective, clustering water storage for > 90 days also seemed to have a significant effect depending on the test method. Thus, contingent on the specimen dimensions for each test method, water storage may result in hydrolysis of the adhesive joint similar to thermocycling. In another meta-analytical review of parameters involved in dentin bonding, neither thermocycling nor long-term water storage displayed high sensitivity (less statistical impact), but water storage presented a greater bond-degragading effect.20 Future studies, especially with the microtensile test, should consider the degragading effect of water storage vs thermocycling. Several testing methods (ie, macroshear, microshear, macrotensile, and microtensile tests) have been suggested for evaluation of the bond strength of resin-based materials to dental ceramics. Hence, to measure the bond strength values between an adherent and a substrate accurately, it is crucial that the bonding interface be the most stressed region, regardless of the test methodology employed. Previous studies using stress distribution analyses have reported that some of the bond strength tests do not appropriately stress the interfacial zone.18,19,32,80 Shear tests have been criticized for the development of non-homogeneous stress distributions in the bonded interface, inducing either underestimation or misinterpretation of the results, as the failure often starts in one of the substrates and not at the adhesive zone.18,19,32 Although conventional tensile tests also present some limitations, such as the difficulty of specimen alignment and the tendency for heterogeneous stress distribution at the adhesive interface, this type of test was proposed to provide information on global bond strength. On the other hand, the microtensile test allows better alignment of the specimens and a more homogeneous distribution of stress, in addition to a more sensitive comparison or evaluation of bond performances.9 According to Griffith’s theory,26 the tensile strength of uniform materials decreases when the specimen size is increased. This outcome is a function of the distribution of defects in the material, since the larger bonded areas of the beams have more defects than do smaller specimens. This is the reason why macrotensile test results were higher with the MDP-based cement compared to other methods. This systematic review indicated that despite the evidence is published in the dental literature, the macroshear test continues to be more commonly applied. Most probably due to its simplicity, this test method is seen as a quick and repeatable testing option to rank the materials. The microshear test was the least commonly used method in dental adhesion studies. 23

Özcan / Bernasconi

The studied sample contained between 6 and 10 specimens per experimental group. The specimen number per experimental group should always exceed 10. Fewer specimens could be considered as a pilot study for statistical analysis. Although initially intended, failure type analysis could not be classified in this review due to inconsistency. To date, clinically sufficient bond strength is not known. Aiming for higher bond strength data could perhaps be thought unnecessary, given the high values obtained for MDP-based cements tested with the macrotensile test. Retention loss of zirconia-based crowns or FDPs is a rare event according to clinical studies.23,67 Durable adhesion is essential only in the case of minimally invasive resinbonded FDPs made of zirconia. Since many confounding factors are present in clinical trials, in vitro studies will remain important for ranking materials and identifying those that perform best in worst-case scenarios prior to such trials. As adhesion has two aspects, one being to the restoration surface and the other to the tooth, in vitro studies on zirconia should also take adhesion of the resin cement to dentin into consideration. Due to the developments in the field of adhesive promoters and adhesive cements indicated for different restorative materials, in the near future, further studies are also expected to appear in the arena of adhesion to zirconia with new adhesives. Thus, the following remarks are directed at the researchers and those who review their work: y The studies should involve a control group where no conditioning is applied in order to determine the effectiveness of the conditioning method investigated. Each step of surface conditioning procedures should be defined precisely. y A consensus needs to be reached on aging procedures and parameters. Until then, aging via thermocycling for at least 5000 cycles should be applied. y Exact cement composition should be given. y The same research group should verify the performance of the adhesive potential of a system with a second test method. y The bond strength data should be presented with confidence intervals, mean, minimum, and maximum values. y Failure types after bond tests should be described in detail.

Surface conditioning methods, particularly physicochemical conditioning methods, increased the bond strength of resin cements to zirconia. Thermocycling significantly decreased the results compared to the control group, although the number of cycles showed great variation between the studies. When 10 MPa was considered as the common denominator, MDP-based cements provided more favorable adhesion to zirconia even after thermocycling, but selfadhesive and glass-ionomer cements should be used with caution where good adhesion is demanded.

ACKNOWLEDGMENT We would like to thank Dr. Malgorzata Roos, PhD, at the Division of Biostatistics, Institute of Social and Preventive Medicine, University of Zurich, Switzerland, for her assistance with the statistical analysis.

REFERENCES 1.

2.

3. 4.

5.

6.

7.

8.

9.

10.

11.

CONCLUSIONS 12.

From this review, the following could be concluded. Current studies regarding the adhesion of luting cements to zirconia should be evaluated carefully considering the surface conditioning method, cement type, aging conditions, and test method. A more systematic approach, especially regarding aging conditions, is needed when studying adhesion to zirconia. As in the majority of the excluded studies it was lacking, future adhesion studies to zirconia should implement a non-conditioned control group, with exact definition of the conditioning protocol. 24

13.

14.

15. 16.

Abel ML, Allington LD, Digby RP, Porritt N, Shaw SJ, Watts JF. Understanding the relationship between silane application conditions, bond durability and locus of failure. Int J Adhes Adhesives 2006;26:2-15. Aboushelib MN, Kleverlaan CJ, Feilzer AJ. Selective infiltration-etching technique for a strong and durable bond of resin cements to zirconiabased materials. J Prosthet Dent 2007;98:379-388. Aboushelib MN, Feilzer AJ, Kleverlaan CJ. Bonding to zirconia using a new surface treatment. J Prosthodont 2010;19:340-346. Akyil MS, Uzun IH, Bayindir F. Bond strength of resin cement to yttriumstabilized tetragonal zirconia ceramic treated with air abrasion, silica coating, and laser irradiation. Photomed Laser Surg 2010;28:801-808. Amaral R, Özcan M, Bottino MA, Valandro LF. Microtensile bond strength of a resin cement to glass infiltrated zirconia-reinforced ceramic: the effect of surface conditioning. Dent Mater 2006;22:283-290. Atsu SS, Kilicarslan MA, Kucukesmen HC, Aka PS. Effect of zirconiumoxide ceramic surface treatments on the bond strength to adhesive resin. J Prosthet Dent 2006;95:430-436. Attia A, Lehmann F, Kern M. Influence of surface conditioning and cleaning methods on resin bonding to zirconia ceramic. Dent Mater 2011;27:207-213. Behr M, Proff P, Kolbeck C, Langrieger S, Kunze J, Handel G, Rosentritt M. The bond strength of the resin-to-zirconia interface using different bonding concepts. J Mech Behav Biomed Mater 2011;4:2-8. Betamar N, Cardew G, Van Noort R. Influence of specimen designs on the microtensile bond strength to dentin. J Adhes Dent 2007;9: 159-168. Blatz MB, Sadan A, Martin J, Lang B. In vitro evaluation of shear bond strengths of resin to densely-sintered high-purity zirconium-oxide ceramic after long-term storage and thermal cycling. J Prosthet Dent 2004;91:356-362. Blatz MB, Chiche G, Holst S, Sadan A. Influence of surface treatment and simulated aging on bond strengths of luting agents to zirconia. Quintessence Int 2007;38:745-753. Blatz MB, Phark JH, Ozer F, Mante FK, Saleh N, Bergler M, Sadan A. In vitro comparative bond strength of contemporary self-adhesive resin cements to zirconium oxide ceramic with and without air-particle abrasion. Clin Oral Investig 2010;14:187-192. Borges GA, Sophr AM, Goes MF, Sobrinho LC, Chan DCN. Effect of etching and airborne particle abrasion on the microstructure of different dental ceramics. J Prosthet Dent 2003;89:479-488. Bottino MA, Valandro LF, Scotti R, Buso L. Effect of surface treatments on the resin bond to zirconium-based ceramic. Int J Prosthodont 2005;18:60-65. Calamia JR. Etched porcelain veneers: the current state of the art. Quintessence Int 1985;1:5-12. Chua PS, Dai SR, Piggott MR. Mechanical properties of the glass fiberpolyester interphase. Part 2-effect of water on debonding. J Mater Sci 1992;27:919-924.

The Journal of Adhesive Dentistry

Özcan / Bernasconi 17. DeHoff PH, Anusavice KJ, Wang Z. Three-dimensional finite element analysis of the shear bond test. Dent Mater 1995;11:126-131. 18. Della Bona A, Van Noort R. Shear vs. tensile bond strength of resin composite bonded to ceramic. J Dent Res 1995;74:1591-1596. 19. De Munck J, Van Landuyt K, Coutinho E, Poitevin A, Peumans M, Lambrechts P Van Meerbeek B. Micro-tensile bond strength of adhesives bonded to Class-I cavity-bottom dentin after thermo-cycling. Dent Mater 2005;21:999-1007. 20. De Munck J, Mine A, Poitevin A, Van Ende A, Cardoso MV, Van Landuyt KL, Peumans M, Van Meerbeek B. Meta-analytical review of parameters involved in dentin bonding. J Dent Res 2012;91:351-357. 21. Derand P, Derand T. Bond strength of luting cements to zirconium oxide ceramics. Int J Prosthodont 2000;13:131-135. 22. Derand T, Molin M, Kvam K. Bond strength of composite luting cement to zirconia ceramic surfaces. Dent Mater 2005;21:1158-1162. 23. Edelhoff D, Özcan M. To what extent does the longevity of fixed dental prostheses depend on the function of the cement? Working Group 4 materials: cementation. Clin Oral Implants Res 2007;18:193-204. 24. Foxton RM, Cavalcanti AN, Nakajima M, Pilecki P, Sherriff M, Melo L, Watson TF. Durability of resin cement bond to aluminium oxide and zirconia ceramics after air abrasion and laser treatment. J Prosthodont 2011;20:84-92. 25. Gale M, Darvell B. Thermal cycling procedures for laboratory testing of dental restorations. J Dent 1999;27:89-99. 26. Griffith AA. The phenomena of rupture and flow in solids. Phil Trans R Soc London, Ser. A 1920;221:168-198. 27. Guazzato M, Proos K, Quach L, Swain MV. Strength, reliability and mode of fracture of bilayered porcelain/zirconia (Y-TZP) dental ceramics. Biomaterials 2004a;25:5045-5052. 28. Guazzato M, Albakry M, Ringer SP, Swain MV. Strength, fracture toughness and microstructure of a selection of all-ceramic materials. Part II. Zirconia-based dental ceramic. Dent Mater 2004b;20:449-456. 29. Ishida H, Koenig JL. Effect of hydrolysis and drying on the siloxane bonds of a silane coupling agent deposited on E-glass fibers. J Polym Sci Part B Polym Phys 1980;18:233-237. 30. International Organization For Standardization, Metal-resin adhesion, Amendment 1, ISO 10477. Geneva, 1996. 31. Janda R, Roulet JF, Wulf M, Tiller HJ. A new adhesive technology for allceramics. Dent Mater 2003;19:567-573. 32. Jevnikar P, Krnel K, Kocjan A, Funduk N, Kosmac T. The effect of nanostructured alumina coating on resin-bond strength to zirconia ceramics. Dent Mater 2010;26:688-696. 33. Kern M, Thompson VP. Bonding to glass infiltrated alumina ceramic: Adhesive methods and their durability. J Prosthet Dent 1995;73:240-249. 34. Kern M, Barloi A, Yang B. Surface conditioning influences zirconia ceramic bonding. J Dent Res 2009;88:817-822. 35. Kern M, Wegner SM. Bonding to zirconia ceramic: adhesion methods and their durability. Dent Mater 1998;14:64-71. 36. Komine F, Kobayashi K, Saito A. Shear bond strength between an indirect composite veneering material and zirconia ceramics after thermocycling. J Oral Sci 2009;51:629-634. 37. Kosmac T, Oblak C, Marion L. The effects of dental grinding and sandblasting on ageing and fatigue behavior of dental zirconia (Y-TZP) ceramics. J Eur Ceramic Soc 2008;28:1085-1090. 38. Kuriyama S, Terui Y, Higuchi D, Goto D, Hotta Y, Manabe A, Miyazaki T. Novel fabrication method for zirconia restorations: Bonding strength of machinable ceramic to zirconia with resin cements. Dent Mater J 2011;30:419-424. 39. Lehmann F, Kern M. Durability of resin bonding to zirconia ceramic using different primers. J Adhes Dent 2009;11:479-483. 40. Lohbauer U, Zipperle M, Rischka K. Hydroxylation of dental zirconia surfaces: Characterization and bonding potential. J Biomed Mater Res B Appl Biomater 2008;87:461-467. 41. Lu YC, Tseng H, Shih YH, Lee SY. Effects of surface treatments on bond strength of glass-infiltrated ceramic. J Oral Rehabil 2001;28: 805-813. 42. Lüthy H, Loeffel O, Hämmerle CH. Effect of thermocycling on bond strength of luting cements to zirconia ceramic. Dent Mater 2006;22: 195-200. 43. Madani M, Chu FC, McDonald AV, Smales RJ. Effects of surface treatments on shear bond strengths between a resin cement and an alumina core. J Prosthet Dent 2000;83:644-647. 44. Magne P, Paranhos MP, Burnett LH Jr. New zirconia primer improves bond strength of resin-based cements. Dent Mater 2010;26:345-352.

Vol 17, No 1, 2015

45. Matinlinna JP, Lassila LV, Özcan M, Yli-Urpo A, Vallittu PK. An introduction to silanes and their clinical applications in dentistry. Int J Prosthodont 2004;17:155-164. 46. Matinlinna JP, Heikkinen T, Özcan M, Lassila LV, Vallittu PK. Evaluation of resin adhesion to zirconia ceramic using some organosilanes. Dent Mater 2006;22:824-831. 47. Matinlinna JP, Lassila LV, Vallittu PK. Pilot evaluation of resin composite cement adhesion to zirconia using a novel silane system. Acta Odontol Scand 2007;65:44-51. 48. May LG, Passos SP, Capelli DB, Özcan M, Bottino MA, Valandro LF. Effect of silica coating combined to a MDP-based primer on the resin bond to Y-TZP ceramic. J Biomed Mater Res B Appl Biomater 2010;95:69-74. 49. Mirmohammadi H, Aboushelib MN, Salameh Z, Feilzer AJ, Kleverlaan CJ. Innovations in bonding to zirconia based ceramics: Part III. Phosphate monomer resin cements. Dent Mater 2010;26:786-792. 50. Mirmohammadi H, Aboushelib MN, Salameh Z, Kleverlaan CJ, Feilzer AJ. Influence of enzymatic and chemical degradation on zirconia resin bond strength after different surface treatments. Am J Dent 2010;23: 327-330. 51. Monaco C, Cardelli P, Scotti R, Valandro LF. Pilot evaluation of four experimental conditioning treatments to improve the bond strength between resin cement and Y-TZP ceramic. J Prosthodont 2011;20:97-100. 52. Nishigawa G, Maruo Y, Irie M, Oka M, Yoshihara K, Minagi S, Nagaoka N, Yoshida Y, Suzuki K. Ultrasonic cleaning of silica-coated zirconia influences bond strength between zirconia and resin luting material. Dent Mater J 2008;27:842-848. 53. Nothdurft FP, Motter PJ, Pospiech PR. Effect of surface treatment on the initial bond strength of different luting cements to zirconium oxide ceramic. Clin Oral Investig 2009;13:229-235. 54. Ntala P, Chen X, Niggli J, Cattell M. Development and testing of multiphase glazes for adhesive bonding to zirconia substrates. J Dent 2010;38:773-781. 55. Oyagüe RC, Monticelli F, Toledano M, Osorio E, Ferrari M, Osorio R. Effect of water aging on microtensile bond strength of dual-cured resin cements to pre-treated sintered zirconium-oxide ceramics. Dent Mater 2009;25:392-399. 56. Oyagüe RC, Monticelli F, Toledano M, Osorio E, Ferrari M, Osorio R. Influence of surface treatments and resin cement selection on bonding to densely-sintered zirconium-oxide ceramic. Dent Mater 2009;25: 172-179. 57. Özcan M, Alkumru HN, Gemalmaz D. The effect of surface treatment on the shear bond strength of luting cement to a glass-infiltrated alumina ceramic. Int J Prosthodont 2001;14:335-339. 58. Özcan M, Vallittu PK. Effect of surface conditioning methods on the bond strength of luting cement to ceramics. Dent Mater 2003;19:725-731. 59. Özcan M, Lassila LVL, Raadschelders J, Matinlinna JP, Vallittu PK. Effect of some parameters on silica-deposition on a zirconia ceramic. J Adhes Dent 2013;5:211-214. 60. Özcan M, Kerkdijk S, Valandro LF. Comparison of resin cement adhesion to Y-TZP ceramic following manufacturers‘ instructions of the cements only. Clin Oral Investig 2008;12:279-282. 61. Özcan M, Nijhuis H, Valandro LF. Effect of various surface conditioning methods on the adhesion of dual-cure resin cement with MDP functional monomer to zirconia after thermal aging. Dent Mater J 2008;27:99-104. 62. Paranhos MP, Burnett LH Jr, Magne P. Effect Of Nd:YAG laser and CO2 laser treatment on the resin bond strength to zirconia ceramic. Quintessence Int 2011;42:79-89. 63. Passos SP, May LG, Barca DC, Özcan M, Bottino MA, Valandro LF. Adhesive quality of self-adhesive and conventional adhesive resin cement to Y-TZP ceramic before and after aging conditions. Oper Dent 2010;35: 689-696. 64. Piascik JR, Swift EJ, Thompson JY, Grego S, Stoner BR. Surface modification for enhanced silanation of zirconia ceramics. Dent Mater 2009; 25:1116-1121. 65. Plueddemann EP. Silane coupling agents. New York: Plenum Press, 1991. 66. Quaas AC, Yang B, Kern M. Panavia F 2.0 bonding to contaminated zirconia ceramic after different cleaning procedures. Dent Mater 2007;23: 506-512. 67. Raigrodski AJ, Hillstead MB, Meng GK, Chung KH. Survival and complications of zirconia-based fixed dental prostheses: a systematic review. J Prosthet Dent 2012;107:170-177. 68. Re D, Augusti D, Sailer I, Spreafico D, Cerutti A. The effect of surface treatment on the adhesion of resin cements to Y-TZP. Eur J Esthet Dent 2008;3:186-196.

25

Özcan / Bernasconi 69. Scherrer SS, Lorente CM, Vittecoq E, Mestral F, Griggs AJ, Wiskott AWH. Fatigue behavior in water of Y-TZP zirconia ceramics after abrasion with 30 μm silica-coated alumina particles. Dent Mater 2011;27:28-42. 70. Spohr AM, Borges GA, Júnior LH, Mota EG, Oshima HM. Surface modification of In-Ceram Zirconia ceramic by Nd:YAG laser, Rocatec system, or aluminum oxide sandblasting and its bond strength to a resin cement. Photomed Laser Surg 2008;26:203-208. 71. Sun R, Suansuwan N, Kilpatrick N, Swain M. Characterization of tribochemically assisted bonding of composite resin to porcelain and metal. J Dent 2000;28:441-445. 72. Takeuchi K, Fujishima A, Manabe A, Kuriyama S, Hotta Y, Tamaki Y, Miyazaki T. Combination treatment of tribochemical treatment and phosphoric acid ester monomer of zirconia ceramics enhances the bonding durability of resin-based luting cements. Dent Mater J 2010;29: 316-323. 73. Tinschert J, Zwez D, Marx R, Anusavice KJ. Structural reliability of alumina-, feldspar-, leucite-, mica- and zirconia-based ceramics. J Dent 2000;28:529-535. 74. Tsuo Y, Yoshida K, Atsuta M. Effects of alumina-blasting and adhesive primers on bonding between resin luting agent and zirconia ceramics. Dent Mater J 2006;25:669-674. 75. Uo M, Sjögren G, Sundh A, Goto M, Watari F, Bergman M. Effect of surface condition of dental zirconia ceramic (Denzir) on bonding. Dent Mater J 2006;25:626-631. 76. Ural C, Kulunk T, Kulunk S, Kurt M. The effect of laser treatment on bonding between zirconia ceramic surface and resin cement. Acta Odontol Scand 2010;68:354-359. 77. Ural C, Kulunk T, Kulunk S, Kurt M, Baba S. Determination of resin bond strength to zirconia ceramic surface using different primers. Acta Odontol Scand 2010;69:48-53. 78. Valandro LF, Della Bona A, Bottino MA, Neisser MP. The effect of ceramic surface treatment on bonding to densely sintered alumina ceramic. J Prosthet Dent 2005;93:253-259. 79. Valandro LF, Özcan M, Bottino MC, Bottino MA, Scotti R, Bona AD. Bond strength of a resin cement to high-alumina and zirconia-reinforced ceramics: the effect of surface conditioning. J Adhes Dent 2006;8:175-181.

26

80. Valandro LF, Özcan M, Amaral R, Vanderlei A, Bottino MA. Effect of testing methods on the bond strength of resin to zirconia-alumina ceramic: microtensile versus shear test. Dent Mater J 2008;27:849-855. 81. Versluis A, Tantbirojn D, Douglas WH. Why do shear bond tests pull out dentin? J Dent Res 1997;76:1298-1307. 82. Wegner SM, Kern M. Long-term resin bond strength to zirconia ceramic. J Adhes Dent 2000;2:139-147. 83. White SN, Miklus VG, McLaren EA, Lang LA, Caputo AA. Flexural strength of a layered zirconia and porcelain dental all-ceramic system. J Prosthet Dent 2005;94:125-131. 84. Wolfart M, Lehmann F, Wolfart S, Kern M. Durability of the resin bond strength to zirconia ceramic after using different surface conditioning methods. Dent Mater 2007;23:45-50. 85. Yun JY, Ha SR, Lee JB, Kim SH. Effect of sandblasting and various metal primers on the shear bond strength of resin cement to Y-TZP ceramic. Dent Mater 2010;26:650-658. 86. Xible AA, Tavarez RRJ, Araujo CRP, Bonachela WC. Effect of silica coating and silanization on flexural and composite-resin bond strengths of zirconia posts: An in vitro study. J Prosthet Dent 2006;95:224-229. 87. Zhang Y, Lawn BR, Rekow ED, Thompson VP. Effect of sandblasting on the long-term performance of dental ceramics. J Biomed Mater Res B Appl Biomater 2004;71:381-386. 88. Zhang W, Masumi SI, Song XM. Bonding property of two resinreinforced glass-ionomer cements to zirconia ceramic. Quintessence Int 2010;41:132-140.

Clinical relevance: The results of this systematic review indicated that MDP-based resin cement should be the choice of cement after physicochemical conditioning where adhesion is demanded for a zirconia restoration.

The Journal of Adhesive Dentistry

Adhesion to zirconia used for dental restorations: a systematic review and meta-analysis.

Currently, no consensus exists regarding the best adhesion protocol for zirconia used in dentistry; this is important particularly for restorations wh...
170KB Sizes 0 Downloads 11 Views