Zirconia bond strength durability following artificial aging: A systematic review and meta-analysis of in vitro studies

The present study systematically reviewed the literature regarding the bond strength durability of zirconia ceramics to resin-based luting cements after application of different bonding protocols and aging conditions. Electronic searches in PubMed, Scopus, and Web of Science databases were performed for relevant literature published between January 1st 2015 and November 15th 2022. Ninety-three (93) English language in-vitro studies were included. The percentage of the mean bond strength change was recorded prior to and after artificial aging, and the weighted mean values and 95% confidence intervals were calculated. Bonding protocols were classified based on the combination of MDP/non-MDP containing cement/primer and surface pretreatment, as well as the level of artificial aging performed. Alumina sandblasting (SA) was identified as the most frequently used surface pre-treatment while an insufficient number of studies was identified for each category of alternative surface treatments. The combination of MDP cement with tribochemical silica coating (TSC) or SA yielded more durable results after aging, while the application of SA and TSC improved bond durability when a non-MDP cement and a non-MDP primer were used. TSC may lead to increased bond durability compared to SA, whereas MDP cements may act similarly when combined with SA or TSC.

A Study to Evaluate the Effect of Cleaning Solutions on Shear Bond Strength of Resin Cement to Saliva-Contaminated Lithium Disilicate (LDS) Ceramic

BACKGROUND

One of the greatest benefits of contemporary restorative dentistry is the creation of fixed partial dentures. The retention and durability of the fixed partial dentures may be improved by using a variety of tooth preparation methods, surface treatments, and luting resins.

AIM

To measure the shear binding strength of resin cement to saliva-contaminated lithium disilicate (LDS) ceramic after being exposed to various cleaning treatments.

METHODOLOGY

Over 30 LDS samples were examined. In Group 1, a cleansing solution comprising 15% zirconium oxide (Ivoclean) was employed for a duration of 20 s. This was succeeded by a rinsing phase lasting 15 s utilizing deionized water, followed by a 15-s period for drying. Subsequently, a final stage of air drying was conducted over a span of 15 s. In contrast, Group 2 underwent a washing procedure of 20 s involving a cleansing solution containing 30% sodium silicate. This was then ensued by a rinsing interval of 15 s with deionized water, succeeded by an air-drying process spanning 15 s. After applying cleaning solutions to the surface and adhering the specimens to the composite blocks using resin cement Multilink Automix (Ivoclar Vivadent, Schaan, Liechtenstein), the shear bond strength was assessed.

RESULTS

Using a 30% sodium silicate solution (Group 2), we were able to get the highest mean shear bond strength value after saliva-contaminated LDS. Group 1, 15% zirconium oxide (Ivoclean) had the weakest decontamination agents as measured by mean shear bond strengths. The shear bond strength values of the two groups were found to vary significantly between individuals using the independent sample t-test. LDs ceramic cleaned with a 30% sodium silicate solution had a higher shear bond strength than ceramic cleaned with Ivoclean (p<0.05).

CONCLUSION

The application of a 30% sodium silicate solution rendered the highest shear bond strength for saliva-contaminated LDS ceramic. In comparison, ceramic cleaned with Ivoclean exhibited notably lower shear bond strength values. The outcome of this investigation highlights the potential of diverse cleaning agents in influencing the adhesive qualities of resin cement, thereby contributing to the enhancement of fixed partial denture durability and efficacy.

The effects of applying a novel cleaner on the bonding strength of zirconia surfaces

This study evaluates how pre-treatment with an MDP-containing cleaning agent (Katana Cleaner, Kuraray) influences the micro-shear bond strength (µSBS) of saliva-contaminated zirconia when used with universal adhesive (UA) systems. Rectangular specimens (2 mm × 12 mm × 15 mm) were obtained (IPS, e.max ZirCAD, MO, B65L17, Ivoclar Vivadent) and divided into three groups; a non-contaminated group (control group)(CON), a contaminated and cleaned with isopropyl alcohol group(ISP), and lastly, a group contaminated and cleaned with an MDP-containing cleaning agent(KAC). Each group was then subdivided into three subgroups according to the UAs used (n = 12). Composite cylinders were prepared and bonded to each surface with Panavia V5 (Kuraray, Noritake Dental). A µSBS test was performed and the data were evaluated with the two-way analysis of variance (two-way ANOVA) and multiple comparisons test (α = 0.05). The highest µSBS values were obtained in the non-contaminated group (p < 0.001), regardless of UAs. All subgroups showed lower µSBS values after saliva contamination, but KAC resulted in significantly higher µSBS values than 99% isopropanol (p < 0.001). Overall, the lowest µSBS value was obtained with 99% isopropanol. The KAC-Clearfil UA subgroup resulted in statistically significantly higher µSBS values than the other UAs (p = 0.035 and 0.007), although all three UAs resulted in sufficient µSBS values. This study revealed that applying KAC followed by a UA containing phosphate monomers produces promising results for improving µSBS values of zirconia, greater than results using 99% isopropanol.Clinical relevance: An MDP-containing cleaning agent followed by a phosphate monomer containing a universal adhesive is a promising method to obtain acceptable bonds with saliva-contaminated zirconia ceramics.

Effect of different cleansing methods on the artificially aged bond strength of resin to contaminated zirconia: A systematic review

PURPOSE

The aim of this review was to evaluate studies investigating the effect of cleansing methods on the artificially aged bond strength of resin to contaminated zirconia restorations and determine which cleansing method of contaminated zirconia for resin bonding improvement is more efficient.

METHODS

An electronic search of published studies in English language was carried out until July 2021 on Scopus, Web of Science, and Medline databases. Data from in vitro studies involving the evaluation of the artificially aged bond strength of resin to contaminated zirconia following different cleansing methods were included. In vitro studies in which samples were not subjected to at least 5000 thermocycles, were excluded.

RESULTS

Of 162 articles retrieved initially, 19 were eligible to be included in the systematic review, of which 5 articles were excluded. Therefore, the final sample was 14 in vitro studies. All of the included studies for air abrasion suggested this method as an effective cleansing method, but 6 of 8 included studies reported cleaning paste (Ivoclean) as an effective cleansing method. All of the included studies for NaOCl and a cleaning gel (AD Gel) reported their efficacy. Finally, the results of included studies showed the ineffectiveness of phosphoric acid, water, isopropanol, enzymatic detergents, hydrogen peroxide, and acetone.

CONCLUSIONS

Air abrasion has been reported as an effective cleansing method to improve the bond strength of resin to contaminated zirconia. To improve the effectiveness of cleaning paste in resin bonding, another efficient cleansing method should be followed after this method. However, the superior cleaning potential of air abrasion rather than cleaning paste has been reported. Sodium hypochlorite and cleaning gel seem to be as effective as air abrasion, but extensive water-rinsing is necessary after the application of these cleaning agents.

Effect of ethyl cellulose coating as an evaluation agent against contamination on the bond strength of zirconia restorations: An in vitro study

STATEMENT OF PROBLEM

During the trial placement of zirconia restorations, contamination of the bonding surface is inevitable. Although cleaning methods for contaminated surfaces have been described, a method of preventing saliva contamination of the bonding surface of zirconia restorations is lacking.

PURPOSE

The purpose of this in vitro study was to investigate an ethyl cellulose coating as an evaluation agent to mitigate the effects of saliva contamination on the bond strength of zirconia restorations.

MATERIAL AND METHODS

Experimental groups representing different cleaning methods of tetragonal yttria-stabilized tetragonal zirconia polycrystal (4Y-TZP) surfaces were investigated for shear bond strength with a resin luting agent, and the failure mode was analyzed. The 9.0×7.0×5.0-mm zirconia blocks (n=72) were assigned as follows: Group N: uncontaminated control; Group CU: contaminated with saliva, followed by ultrasonic cleaning with ethanol; Group CI: contaminated with saliva, followed by application of a zirconia cleaner; Group PCW: preapplication of a zirconia primer, contaminated with saliva, followed by cleaning with water spray; Group ECU: precoating with the ethyl cellulose agent, contaminated with saliva, followed by removal of the agent in an ultrasonic bath with ethanol. Each group was divided into 3 subgroups (immediate, short-term aging, and long-term aging), and the shear bond strength was measured (n=24). To analyze the bonding surface characteristics, the contact angle was measured (n=5). The surfaces of the zirconia specimens in each experimental group were evaluated by using a field emission scanning electron microscope (n=5). Time-of-flight secondary ion mass spectroscopy was used for the chemical analysis of the conditioned surfaces (n=3). A 2-way analysis of variance (ANOVA) with main effect model for shear bond strength results and a 1-way ANOVA for contact angle data were performed as statistical analysis, followed by the Bonferroni post hoc test (α=.05).

RESULTS

The shear bond strength was significantly higher in the ECU group than in the groups with the other cleaning methods (P<.05). After the removal of ethyl cellulose with ethanol, the contact angle and surface topography were found to be similar to those of the control group, and no saliva contaminants were identified in the spectroscopy analysis.

CONCLUSIONS

Coating with ethyl cellulose may protect the bonding surface of zirconia restorations from salivary contamination better than cleaning a contaminated surface.

Revolution of Current Dental Zirconia: A Comprehensive Review

The aim of this article is to comprehensively review the revolution of dental zirconia (Zir), including its types, properties, applications, and cementation procedures. A comprehensive search of PubMed and Embase was conducted. The search was limited to manuscripts published in English. The final search was conducted in October 2021. Newly developed monolithic Zir ceramics have substantially enhanced esthetics and translucency. However, this material must be further studied in vitro and in vivo to determine its long-term ability to maintain its exceptional properties. According to the literature, monolithic translucent Zir has had promising results and a high survival rate. Thus, the utilization of this material is indicated when strength and esthetics are needed. Both the materials and methods used for cementation of monolithic Zir have significantly improved, encouraging dentists to use this material, especially when a conservative approach is required. Zir restorations showed promising outcomes, particularly for monolithic Zir crowns supported with implant and fixed dental prostheses.

The effect of different cleaning agents and resin cement materials on the bond strength of contaminated zirconia

The purpose of this study was to examine the effect of different cleaning methods and resin cements on the shear bond strength (SBS) of contaminated zirconia. A total of 92 disc-shaped zirconia specimens were contaminated with different procedures. Then, the specimens were grouped according to cleaning methods and resin cements: no cleaning + Variolink Esthetic DC (CN_V ), no cleaning + Panavia V5 (CN_P ), sandblasted + Variolink Esthetic DC (SB_V ), sandblasted + Panavia V5 (SB_P ), Ivoclean + Variolink Esthetic DC (IC_V ), Ivoclean + Panavia V5 (IC_P ), Katana Cleaner + Variolink Esthetic DC (KC_V ), and Katana Cleaner + Panavia V5 (KC_P ). Following an aging protocol in a 37°C for 1 week, SBS analysis was performed with a universal test machine. For the surface topography and elemental analysis, scanning electron microscopy and energy-dispersive X-ray spectroscopy (EDS) were used. Significance was evaluated as p < .05 and p < .01. The highest SBS results were found in the SB_P group, showing a statistically significant difference from all other groups (p < .05). For the same cleaning method, Panavia V5 showed statistically significantly higher SBS values than Variolink Esthetic DC (p < .01), except the CN_P -CN_V (p = .880) and KC_P -KC_V (p = .082) groups. The most detected surface elements by EDS were Zr, O, C, and N, respectively. The contaminated zirconia surfaces must be cleaned for successful adhesion. The use of phosphate-containing adhesives in combination with sandblasting will increase the adhesion strength, and universal cleaning agents can be a good alternative to sandblasting.

Microshear bond strength of dual-cure resin cement in zirconia after different cleaning techniques: an in vitro study

PURPOSE

This study aimed to compare the microshear bond strength (µSBS) of dual-cure resin cement in CAD-CAM zirconia after different cleaning techniques.

MATERIALS AND METHODS

Fifty discs of zirconia-based ceramic from Ivoclar Vivadent were embedded in acrylic resin. The discs were divided into five groups according to the cleaning methods used: Group 1: drying with spraying + sandblasting with Al₂O₃; Group 2: washed with water and dried with spraying + sandblasting with Al₂O₃; Group 3: washed with distilled water and dried with spraying + sandblasting with Al₂O₃ + zirconium oxide (Ivoclean); Group 4: washed with distilled water and dried with spraying + sandblasting with Al₂O₃ + potassium hydroxide (Zirclean); and Group 5: washed with distilled water and dried with spraying + sandblasting with Al₂O₃ + 1% NaClO. All of the groups were contaminated with artificial saliva for 1 minute and then cleaned. Statistical analyses were performed using ANOVA and Tukey's tests.

RESULTS

There were statistically significant differences among all groups for µSBS (P < .05). The group treated with zirconium oxide (Group 3) showed the highest µSBS (18.75 ± 0.23 MPa).

CONCLUSION

When applied to zirconia, the cleaning methods affected the bonding with resin cement differently.

Influence of 10-methacryloyloxydecyl dihydrogen phosphate (MDP) incorporated experimental cleaners on the bonding performance of saliva-contaminated zirconia ceramic

OBJECTIVES

To assess the efficacy of experimental cleaners containing 10-methacryloyloxydecyl dihydrogen phosphate (MDP) on the saliva decontamination of ceramic and their influence in restoring zirconia's adherence to resin cement.

MATERIALS AND METHODS

Four hundred sixty alumina-blasted zirconia specimens were categorized into saliva-contaminated and uncontaminated groups which were treated with ceramic primer (P), experimental cleaner 1 (C1), C1 followed by P (C1P), experimental cleaner 2 (C2), and C2 followed by P (C2P). Stainless-steel rods were then attached to the specimens using PanaviaV5 cement (Kuraray Noritake Dental; Tokyo, Japan). Tensile bond strength (TBS) test was performed after 24 h and 5000 thermocycling processes. X-ray photoelectron spectroscopy (XPS) analysis and contact angle measurement of the specimen were performed. The TBS data were analyzed by Weibull analysis and three-way ANOVA. Contact angle data were analyzed by two-way ANOVA (α = 0.05).

RESULTS

C2P groups showed the highest TBS in all conditions among tested groups. Saliva contamination led to a significant reduction of TBS in primer- and cleaner-treated groups, with no significant impact on C2P. Adhesive failure was predominant in contaminated groups except with the C1P and C2P groups. XPS revealed that a nitrogen peak was observed on contaminated groups but not in primed groups. The contact angle was significantly affected by saliva contamination, the cleaners, and/or ceramic primer usage (p < 0.001).

CONCLUSIONS

The MDP cleaner followed by the MDP primer protocol may overcome the effect of saliva contamination and improve the resin-ceramic bond strength.

CLINICAL RELEVANCE

It is recommended to use a combination of MDP-containing cleaner 2 and ceramic primer as a chair-side chemical pretreatment for zirconia substrate with or without saliva contamination.

Cleaning Zirconia Surface Prior To Bonding: A Comparative Study of Different Methods and Solutions

PURPOSE

To evaluate resin cement bond strength after removal of salivary contamination from a zirconia surface using different cleaning solutions and air-borne particle abrasion.

MATERIALS AND METHODS

One-hundred and twenty zirconia specimens (KATANA STML, Noritake) were prepared and divided into 12 groups (n = 10). Groups were subjected to a notched-edge shear bond strength test (ISO 29022) to analyze the bonding efficiency of a resin cement (Panavia V5, Kuraray Noritake Dental Inc.) before and after contamination with saliva. Group 1 (control) was prepared and cemented without salivary contamination. Group 2 was coated with ceramic primer (Clearfil Ceramic Primer Plus, Kuraray Noritake Dental Inc.) then subjected to salivary contamination then tested. Group 3 was contaminated, cleaned by air-borne particle abrasion, ceramic primer and resin cement applied, and tested. Groups 4 to 12 were contaminated, and then different cleaning solutions (water, 4.5% hydrofluoric acid, 35% phosphoric acid, Ivoclean, KATANA cleaner, Zirclean, sodium hypochlorite 4%, and 7.5%) were used to decontaminate the zirconia surface, followed by ceramic primer, resin cement application, and tested. One-way ANOVA and Tukey post-hoc analysis was used to analyze the data.

RESULTS

One-way ANOVA showed statistical differences among cleaning procedures (p < 0.001, F = 13.48). Air-borne particle abrasion was the only group which provided a bond strength (21 ± 2.8 MPa) that was not statistically different than the control group in which no contamination occurred (25.3 ± 3.3 MPa) (p = 0.247). The use of hydrofluoric acid and zirconia cleaning solutions resulted in bond strengths values which were not statistically different from each other (17.5-19.1 MPa).

CONCLUSION

Air-borne particle, zirconia cleaning solutions and hydrofluoric acid are feasible to decontaminate the zirconia surface from saliva prior to bonding the restoration.

Influence of different cleaning procedures on the shear bond strength of 10-methacryloyloxydecyl dihydrogen phosphate-containing self-adhesive resin cement to saliva contaminated zirconia

PURPOSE

To evaluate the effect of different cleaning methods on the shear bond strength (SBS) of a 10-methacryloyloxydecyl dihydrogen phosphate (MDP)-containing self-adhesive resin cement to zirconia after saliva contamination.

METHODS

Sixty zirconia specimens were randomly divided into four groups (n=15) according to treatment surface. Except for the control group, all samples were contaminated with saliva and were then rinsed with water-spray and air-dried. Subsequently, the specimens were either treated with a cleaning paste (CP), with argon plasma (AP), or did not undergo an additional cleaning process (WS). An MDP-containing self-adhesive resin cement was applied onto the ceramic surfaces. Specimens were stored in water (24 hours) followed by thermocycling (5°C to 55°C for 10.000 cycles). SBS tests were performed in a universal testing machine, and the results (MPa ± SD) were statistically analyzed using ANOVA and Bonferroni post-hoc test. Fractured surfaces were examined to identify the failure types using a stereomicroscopy and SEM.

RESULTS

The surface cleaning treatment (p < 0.05) significantly affected the results. The highest SBS values were observed in the control group (12.16 ± 1.22 MPa) and were statistically comparable to values for the CP group (11.38 ± 1.65 MPa). The AP group (9.17 ± 1.06 MPa) showed significantly higher bond strength than the WS group (6.95 ± 1.20 MPa), but it showed significantly lower strength than the control and CP groups.

CONCLUSIONS

The CP application was the most effective method in removing saliva contamination. The AP treatment could not restore the SBS to the same level as uncontaminated specimens.

Effect of Cleaning Protocol on Bond Strength between Resin Composite Cement and Three Different CAD/CAM Materials

The present investigation tested the effect of the cleaning method on the tensile bond strength (TBS) between one resin composite cement (RCC) and three different computer aided design/computer aided manufacturing (CAD/CAM) materials, namely zirconia, lithium disilicate ceramic and resin composite. Ninety specimens were prepared from each CAD/CAM material (N = 270). The specimens were pre-treated respectively, divided into five subgroups and subjected to five different cleaning protocols, namely i. 37% phosphoric acid, ii. ethanol, iii. phosphoric acid + ethanol, iv. cleaning paste, v. distilled water. After cleaning, the specimens were either conditioned using a universal primer or a universal adhesive and bonded using a dual-curing RCC. After thermo-cycling (20,000x at 5 °C/55 °C), TBS and fracture patterns were evaluated. The data was analyzed using 1- and 2-way Analysis of Variance (ANOVA) with post-hoc Scheffé and partial eta-squared (ƞ_P²), Kruskal-Wallis, Mann-Whitney U and Chi² tests (p < 0.05). The CAD/CAM material showed an impact on the BS while the cleaning protocol did not affect the results. Zirconia obtained the highest BS, followed by lithium-disilicate-ceramic. Resin composite resulted in the overall lowest BS. For most fracture patterns, the cohesive type occurred. All tested cleaning protocols resulted in same BS values within one CAD/CAM material indicating that the impact of the cleaning method for the restorative material seems to play a subordinate role in obtaining durable bond strength to resin composite cement. Further, it indicates that the recommended bonding protocols are well adjusted to the respective materials and might be able to compensate the impact of not accurately performed cleaning protocols.

Effect of zirconia decontamination protocols on bond strength and surface wettability

OBJECTIVE

To evaluate the effects of human saliva decontamination protocols on bond strength of resin cement to zirconia (Y-PSZ), wettability, and microbial decontamination.

MATERIALS AND METHODS

Zirconia plates were sandblasted and divided into (a) not contaminated, (b) contaminated with human saliva and: (c) not cleaned, (d) cleaned with air-water spray, (e) cleaned with 70% ethanol, (f) cleaned with Ivoclean, or (g) cleaned with nonthermal atmospheric plasma (NTAP). The wettability and microbial decontamination of the surfaces were determined after saliva contamination or cleaning. Monobond Plus (Ivoclar Vivadent) was applied after cleaning, followed by Variolink LC (Ivoclar Vivadent). The samples were stored 1 week before shear bond strength (SBS) testing, and data (SBS and wettability) were analyzed by one-way analysis of variance and Tukey test (α = .05).

RESULTS

Saliva contamination reduced SBS to zirconia compared to not contaminated. Both Ivoclean and NTAP produced higher SBS compared to not cleaned and were not significantly different from the not contaminated. Ivoclean produced the highest contact angle, and NTAP the lowest. With the exception of using just water-spray, all cleaning protocols decontaminated the specimens.

CONCLUSIONS

Both Ivoclean and NTAP overcame the effects of saliva contamination, producing an SBS to zirconia comparable to the positive control.

CLINICAL SIGNIFICANCE

Dental ceramics should be cleaned prior to resin cementation to eliminate the effects of human saliva contamination, and Ivoclean and NTAP are considered suitable materials for this purpose.

Strength and aging resistance of monolithic zirconia: an update to current knowledge

New zirconia compositions with optimized esthetic properties have emerged due to the fast-growing technology in zirconia manufacturing. However, the large variety of commercial products and synthesis routes, make impossible to include all of them under the general term of “monolithic zirconia ceramics”. Ultra- or high translucent monolithic formulations contain 3–8 mol% yttria, which results in materials with completely different structure, optical and mechanical properties. The purpose of this study was to provide an update to the current knowledge concerning monolithic zirconia and to review factors related to strength and aging resistance. Factors such as composition, coloring procedures, sintering method and temperature, may affect both strength and aging resistance to a more or less extend. A significant reduction of mechanical properties has been correlated to high translucent zirconia formualtions while regarding aging resistance, the findings are contradictory, necessitating more and thorough investigation. Despite the obvious advantages of contemporary monolithic zirconia ceramics, further scientific evidence is required that will eventually lead to the appropriate laboratory and clinical guidelines for their use. Until then, a safe suggestion should be to utilize high-strength partially-stabilized zirconia for posterior or long span restorations and fully-stabilized ultra-translucent zirconia for anterior single crowns and short span fixed partial dentures.

Effect of cleaning agent, primer application and their combination on the bond strength of a resin cement to two yttrium-tetragonal zirconia polycrystal zirconia ceramics

Objective:

The objective of this study is to evaluate the effect of a cleaning agent and priming on the bond strength (BS) of a resin cement (RC) to zirconia ceramics after 24 h and 1 year of water-storage.

Materials and Methods:

Fifty-six Katana and 56 ZirCAD zirconia ceramic plates were prepared and each zirconia brand was divided into four groups (n = 14): (1) untreated; (2) treated with Ivoclean cleaning agent; (3) treated with Monobond Plus coupling agent; (4) treated with Ivoclean + Monobond Plus. Cleaning and coupling agents were applied to zirconia following the manufacturers' instructions. The RC was manipulated, inserted into tubes (0.75 mm diameter/1 mm height) that were positioned on the zirconia surfaces and light activated. Specimens were tested after 24 h and 1 year of water storage. A shear load was applied to the base of the RC cylinders (until failure. Data were analyzed by three-way ANOVA and Tukey tests (α = 5%).

Results:

No significant difference in BS was noted between zirconia ceramics, except when the combination of cleaning and coupling agents was used. This combination increased the BS for Katana zirconia. One year of water storage leads to a decrease in BS for all experimental groups.

Conclusion:

The combination of cleaning agent and priming can yield higher BS for Katana at 24 h. BS to zirconia ceramics reduced approximately 50% after 1 year.

Monolithic Zirconia: An Update to Current Knowledge. Optical Properties, Wear, and Clinical Performance

The purpose of this paper was to update the knowledge concerning the wear, translucency, as well as clinical performance of monolithic zirconia ceramics, aiming at highlighting their advantages and weaknesses through data presented in recent literature. New ultra-translucent and multicolor monolithic zirconia ceramics present considerably improved aesthetics and translucency, which, according to the literature reviewed, is similar to those of the more translucent lithium disilicate ceramics. A profound advantage is their high strength at thin geometries preserving their mechanical integrity. Based on the reviewed articles, monolithic zirconia ceramics cause minimal wear of antagonists, especially if appropriately polished, although no evidence still exists regarding the ultra-translucent compositions. Concerning the survival of monolithic zirconia restorations, the present review demonstrates the findings of the existing short-term studies, which reveal promising results after evaluating their performance for up to 5 or 7 years. Although a significant increase in translucency has been achieved, new translucent monolithic zirconia ceramics have to be further evaluated both in vitro and in vivo for their long-term potential to preserve their outstanding properties. Due to limited studies evaluating the wear properties of ultra-translucent material, no sound conclusions can be made, whereas well-designed clinical studies are urgently needed to enlighten issues of prognosis and long-term survival.

Adhesion to Zirconia: A Systematic Review of Current Conditioning Methods and Bonding Materials

Background. Reliable bonding between resin composite cements and high strength ceramics is difficult to achieve because of their chemical inertness and lack of silica content that makes etching impossible. The purpose of this review is to classify and analyze the existing methods and materials suggested to improve the adhesion of zirconia to dental substrate by using composite resins, in order to explore current trends in surface conditioning methods with predictable results. Methods. The current literature, examining the bond strength of zirconia ceramics, and including in vitro studies, clinical studies, and a systematic review, was analyzed. The research in the literature was carried out using PubMed and Cochrane Library databases, only papers in English, published online from 2013 to 2018. The following keywords and their combinations were used: Zirconia, 3Y-TZP, Adhesion, Adhesive cementation, Bonding, Resin, Composite resin, Composite material, Dentin, Enamel. Results. Research, in PubMed and Cochrane Library databases, provided 390 titles with abstracts. From these, a total of 93 publications were chosen for analysis. After a full text evaluation, seven articles were discarded. Therefore, the final sample was 86, including in vitro, clinical studies, and one systematic review. Various adhesive techniques with different testing methods were examined. Conclusions. Airborne-particle abrasion and tribo-chemical silica coating are the pre-treatment methods with more evidence in the literature. Increased adhesion could be expected after physico-chemical conditioning of zirconia. Surface contamination has a negative effect on adhesion. There is no evidence to support a universal adhesion protocol.

The effect of air-particle abrasion and a zirconia primer application on resin cement bonding strength to zirconia

BACKGROUND

This study aimed to evaluate the influence of surface treatments on the bond strength between a zirconia-based ceramic and two resin cements.

METHODS

Eighty blocks (5.25×3.74×4.5 mm) of a zirconia-based ceramic were divided into eight groups (N.=10) according to the factors "surface treatment" (air-particle abrasion with Al2O3 or Al2O3/SiO2 and zirconia primer) and "cement" (conventional resin cement and self-adhesive resin cement). After the surface treatments, cylinders of each resin cement (Ø=3.5 mm, height: 3 mm) were built up on the zirconia surface and photo-activated (40 s). The samples were stored in water for 30 days at 37 °C, followed by shear bond strength test in a universal testing machine (1 mm/min). Data were analyzed by ANOVA and Tukey test (α=0.05).

RESULTS

Regarding the surface treatments, all strategies were statistically different from each other. The Cojet achieved the higher bond strength values, followed by Signum Zirconia Bond. The resin cements were also statistically different from each other, since the U200 achieved higher bond strength values. The interaction between the factors was also significant. Most of the failures were adhesive and mixed.

CONCLUSIONS

Regardless of the cement used, the air-particle abrasion with alumina coated by silica particles improved bond strength.

Effect of Surface Cleaning Regimen on Glass Ceramic Bond Strength

This study investigated the effect of saliva contamination on chemical changes of ceramic surface as well as the influence of saliva cleaning methods on ceramic-resin bond strength. Saliva was used to contaminate leucite (LGC) and lithium disilicate (LDGC) glass ceramic surfaces. The following cleaning methods were tested: water spray, cleaning with orthophosphoric acid, universal cleaning paste, ultrasonic cleaning with water, re-etching with hydrofluoric acid. Non-contaminated ceramic sample served as control. Chemical analysis of ceramic surfaces was performed using time-of-flight secondary ion mass spectrometry (TOF-SIMS). Shear bond strength (SBS) of ceramics to resin material was tested after 24-hour water storage and after thermocycling. The most effective cleaning method of saliva-contaminated ceramic surface was cleaning LGC surface with orthophosphoric acid or re-etching the LDGC surface with hydrofluoric acid. The application of the following methods resulted in obtaining reliable bond strength.

Influência do método de limpeza da zircônia na adesão da prótese após a contaminação com saliva

Resumo Introdução A contaminação das restaurações de zircônia com saliva antes da cimentação influencia na resistência da adesão face à afinidade com os íons da saliva. Objetivo Analisar os métodos de limpeza da zircônia na adesão à dentina após a contaminação com saliva. Material e método Oitenta amostras de zircônia com dimensão 4×11×3 mm foram cortadas de blocos pré-sinterizados (3Y-TZP, In-Ceram - VITA) e sinterizadas. Após a sinterização, as amostras foram jateadas com partículas de óxido de alumínio, lavadas em água destilada e divididas em dois grupos com base no tipo de cimento de adesão: RelyX U200 Clicker® (grupo R) ou Multilink N® (grupo M). As amostras foram divididas em quatro subgrupos (n=10) de acordo com os métodos de limpeza e com o tipo de cimento: RG1 e MGI (sem contaminação com saliva); RG2 e MG2 (sem contaminação e limpeza com Ivoclean®); RG3 e MG3 (com contaminação e limpeza com água); RG4 e MG4 (com contaminação e limpeza com Ivoclean®). Após a cimentação, as amostras foram armazenadas em água por 10 dias. A resistência da adesão foi determinada pelo teste de cisalhamento. Resultado Os resultados mostraram que a maior e a menor resistência foram do Grupo RG2 e MG2, respectivamente. Entre as amostras cimentadas com RelyXTM, somente o grupo RG4 apresentou diferença na resistência da adesão (p=0,018) em relação aos demais subgrupos. Entre os grupos cimentados com Multilink N®, não houve diferença estatística (p>0,05) na resistência. Conclusão Os resultados mostraram que o agente de limpeza Ivoclean® não foi efetivo na descontaminação e não influenciou na resistência ao cisalhamento.

Bond and topography evaluation of a Y-TZP ceramic with a superficial low-fusing porcelain glass layer after different hydrofluoric acid etching protocols

Abstract Introduction Despite being one of the most studied ceramics today, zirconia still does not have a well-defined adhesion protocol. Objective Evaluate the influence of different etching times and hydrofluoric acid (HF) concentrations on the zirconia surface and bond strength between a vitrified Y-TZP ceramic and a resin cement. Materials and method The zirconia surface treatments were: sandblasting with silica-coated alumina (Co); glaze application + 5% HF etching for 5s (G5-5s), 10s (G5-10s) or 20s (G5-20s); glaze application + 10% HF etching for 5s (G10-5s), 10 (G10-10s) or 20s (G10-20s) . Then, cement cylinders (3.3 × 3.3 mm) were built up for shear bond test on all specimens. The specimens were subjected to 6000 thermal cycling before the test. Fractures were analyzed by stereomicroscope. Data were statistically analyzed by Kruskal-Wallis and Dunn statistical tests (5%). Extra samples of each group were made to obtain profilometry and scanning electron microscopy (SEM). Result Zirconia-cement bond strength was affected by the ceramic surface treatments (p = 0.001). G10-5s (2.71 MPa) recorded the highest bond strength values, followed by the Co (2.05 MPa) while G5 groups had the lowest bond value. Adhesive failure of the samples predominated. The image analysis revealed G5 groups seem to have a lower roughness when compared to groups treated by 10% HF. The creation of pores in the low-fusing porcelain glass layer surface occurred only when 10% HF was used. Conclusion The low-fusing porcelain glass layer application was able to overcome the sandblasting and obtain a greater adhesive bond to the resinous cement, however, only when 10% HF was used for an interval of 5 seconds.

The effect of different cleaning agents on saliva contamination for bonding performance of zirconia ceramics

The effects of contamination and cleaning methods on bonding of self-adhesive resin cement to zirconia ceramics were examined. Airborne particle-abraded zirconia (Zpex Smile) specimens were divided into the following four groups: control (con), contaminated with saliva and cleaned with tap water (HS), cleaned with Ivoclean (IC), and cleaned with Multi Etchant (ME). The pretreated specimens were bonded using three self-adhesive resin cements, and tensile bond strengths were measured using a universal testing machine at a crosshead speed of 2 mm/min. Con and IC groups showed significantly higher bond strength than those of HS and ME groups. Separately, the surface chemical composition of the groups was determined using X-ray photoelectron spectroscopy (XPS). XPS revealed that the N/Zr ratio increased in the HS group but decreased in the IC and ME groups. Cleaning agents can improve the adverse effect of saliva contamination on zirconia, but this effect varies depending on the product.

Effect of Decontamination and Cleaning on the Shear Bond Strength of High Translucency Zirconia

(1) Background: This study evaluated the bonding performance of high translucency zirconia after diverse surficial decontamination and cleaning procedures. (2) Methods: High translucency zirconia (Lava^TM Esthetic) specimens (2.0 mm × 20 mm × 10 mm) were exposed to different surface treatments prior to bonding to CoCr cylinders (d = 5 mm, height = 3 mm). All surfaces were sandblasted (40 µm aluminum oxide, 2 bar) and treated with alcohol (al), saliva (s), saliva + water (sw), or saliva + NaOCl + water (sn) before bonding was performed with the following adhesive luting systems: RelyX^TM Unicem 2 (RX), Scotchbond^TM Universal (SBU) + RelyX^TM Ultimate (RU) or Monobond Plus (MP) + Multilink^® Automix (ML). After 24 h, thermocycling (TC:12,000 × 5 °C/55 °C) and 90 days of storage at 37 °C in distilled water, the shear bond strength (SBS) was evaluated according to ISO/TS 11,405:2015. Failure modes along bonding areas were characterized. Means and standard deviations (n = 10 per group) were determined and statistically analyzed with one-way ANOVA/Bonferroni (α = 0.05). (3) Results: The SBS after 24 h varied between 3.5 (sRX) and 69.4 MPa (snMP + ML). Values from 0 (sRX) to 70.3 MPa (swRX) were found after TC. Data after 90 days of storage showed the lowest values for sRX (0 MPa) and the highest values for alSBU + RU (75.5 MPa). Adhesive failure was noted at all aging conditions. (4) Conclusions: SBU + RU or RX and MP + ML including saliva decontamination of the ceramic surface with water or NaOCl + water allow efficient bonding to Lava^TM Esthetic.

Cleaning Methods for Zirconia Following Salivary Contamination

PURPOSE

To determine the best method of cleaning saliva-contaminated zirconia in preparation for resin bonding.

MATERIAL AND METHODS

Flat blocks of zirconia were particle abraded with aluminum oxide and divided into eight groups (n = 10). Groups 1 to 4 were first treated with one coat of an MDP primer (Z-prime Plus) and groups 5 to 8 were left untreated. A thin coat of fresh whole saliva was painted on all specimens (except the control, group 1) and left in contact for 3 minutes. The specimens were then cleaned by rinsing with water for 20 seconds (groups 2 and 5), or cleaned with 35% phosphoric acid for 20 seconds and rinsed (groups 3 and 6), or cleaned with a zirconia cleaning solution (Ivoclean) for 20 seconds and rinsed (groups 4 and 7), or abraded with aluminum oxide particles and rinsed (group 5). Following the cleaning procedure, groups 5 to 8 were treated with one coat of Z-prime Plus. A 2.5 mm diameter tube was filled with composite (Z100), affixed to the zirconia surface, and light-cured. Specimens were stored in water (37°C for 24 hours) followed by thermocycling (5°C to 55°C for 10,000 cycles). Shear bond strength testing was performed at a crosshead speed of 1 mm/min. Bond strength values were compared to the control using a Dunnett's test (alpha = 0.05). Contact angles of the zirconia specimens with and without Z-prime Plus were measured with water using a goniometer.

RESULTS

Groups 2, 5, and 8 were not significantly different from the control. Application of Z-prime made the zirconia surface more hydrophobic.

CONCLUSIONS

If salivary contamination occurs after MDP application, rinsing off the saliva with water will preserve bond strength. If salivary contamination occurs prior to MDP application, particle abrasion or cleaning with Ivoclean will preserve bond strength.