Zirconia Primers Improve the Shear Bond Strength of Dental Zirconia

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.

Fracture resistance of monolithic translucent zirconia crown bonded with different self-adhesive resin cement: influence of MDP-containing zirconia primer after aging

OBJECTIVES

Successful ceramic restorations depend on the strong bonding with resin cement and even stress distribution. The aim of this study was to evaluate the impact of adding MDP-containing zirconia primer before self-adhesive resin cements with different functional acidic monomers on fracture resistance of monolithic zirconia crown.

MATERIALS AND METHODS

Eighty defect-free human maxillary premolars were divided according to the cement type and application of MDP-containing zirconia primer into eight groups (n = 10): Calibra Universal (C), Calibra Universal combined with zirconia primer (CZ), RelyX U200 (R), RelyXU200 combined with zirconia primer (RZ), Panavia SA Cement Plus (P), Panavia SA Cement Plus combined with zirconia primer (PZ), Multilink Speed (M), and Multilink Speed combined with zirconia primer (MZ). After teeth preparation and fabrication of zirconia crowns, each crown was bonded to its corresponding tooth. All specimens were subjected to 10,000 thermocycles between 5 and 55°C, followed by cyclic load (50 N) for 240,000 cycles. Each specimen was subjected to a static axial load until fracture using universal testing machine and the fracture load was recorded. The fracture mode studied and recorded. The fracture load results were analyzed using two-way ANOVA test (α = 0.05).

RESULTS

A significant interaction (P = 0.038) of combining MDP-containing zirconia primer and cement type on fracture resistance of monolithic zirconia crown was detected. The mean fracture load values of zirconia crown were significantly influenced by the combined application of the MDP-containing zirconia primer with Calibra Universal (P = 0.01), RelyX U200 (P < 0.001), and Multilink Speed (P = 0.038), while there was no significant difference with Panavia SA Cement Plus (P = 0.660). There was significant difference (F = 20.69, P < 0.001) between the mean fracture loads of groups with self-adhesive cements (C, R, P, and M groups). The highest fracture load was recorded with RZ group (2446.90 ± 126.72 N) while the lowest fracture load was recorded with C group (1623.18 ± 149.86 N).

CONCLUSIONS

The self-adhesive resin cement with different acidic functional monomer affects the fracture resistance of monolithic zirconia crown. Application of MDP-containing primer could improve the fracture resistance of monolithic zirconia crown with most self-adhesive cements. The application of an MDP-containing primer had no impact on the fracture resistance of monolithic translucent zirconia crown bonded by MDP-containing self-adhesive resin cement.

Do tooth-supported zirconia restorations present more technical failures related to fracture or loss of retention? Systematic review and meta-analysis

OBJECTIVES

This systematic review was performed to determine the main cause of technical failure of tooth-supported zirconia crowns and fixed partial dentures (FPDs), categorizing them as fracture/chipping or loss of retention/decementation.

MATERIALS AND METHODS

Electronic and manual searches were performed for randomized clinical trials, prospective clinical trials, and prospective cohort studies that reported the technical failure rates of zirconia restorations. The Cochrane Collaboration risk-of-bias tool and Newcastle-Ottawa scale were used to assess the quality of the studies.

RESULTS

Fifty-two studies were included and most of them had unclear risk of bias. Considering all reported fractures/chipping, for veneered crowns with 1 to 3 years of follow-up, the relative risk (RR) of fracture in relation to loss or retention was 3.95 (95% CI 1.18-13.23; p = 0.03). For 4 to 6 years of follow-up, the RR was 5.44 (95% CI 1.41-20.92; p = 0.01). For veneered FPDs with 1 to 3 years of follow-up, the RR was 5.98 (95% CI 2.31-15.01; p = 0.0002). For 4 to 6 years of follow-up, the RR was 3.70 (95% CI 1.63-8.41; p = 0.002). For 7 years or more of follow-up, the RR was 3.45 (95% CI 1.84-6.46; p = 0.0001). When only framework fractures were considered, there were no significant differences for the RR in all follow-up periods (p > 0.05).

CONCLUSIONS

Higher RR for fracture/chipping in relation to decementation for veneered zirconia crowns and FPDs at all follow-up times. For framework fractures, no difference was observed between the risk of failure of the restoration due to fracture or decementation.

CLINICAL RELEVANCE

Zirconia crowns and FPDs showed relatively high success and survival rates. However, considering the technical failures, there is approximately four times higher chance of fracture/chipping than loss of retention for both single and multi-unit tooth-supported veneered zirconia restorations.

Retention strength of monolithic zirconia crowns cemented with different primer-cement systems

BACKGROUND

The purpose of this in vitro study was to assess the influence of different cement systems with different ceramic primers on the retention strength of zirconia crowns.

METHODS

Thirty extracted molars were prepared with flat occlusal surfaces, 20 degrees taper, and 3 mm axial wall height. A zirconia crown with an occlusal bar was fabricated for each tooth. All specimens were divided (n = 10) into; Group M: Multilink Speed/Monobond N, Group P: Panavia V5/Clearfil Ceramic Primer Plus, Group D: Duo-Link universal/Z-Prime Plus. The intaglio surfaces of crowns were air-abraded using 50 µm alumina at 2.5 bar for 10 s. Then each crown was cemented onto its corresponding tooth. All specimens were thermocycled for 10,000 cycles between 5 and 55 °C. Each crown was subjected to gradually increasing vertical load along the path of insertion through hooks engaging the occlusal bar using a universal testing machine until failure. The force at dislodgment was recorded and retention strength was calculated for each specimen. The failure modes were recorded for each specimen. The data were statistically analyzed using one way ANOVA test followed by Tukey HSD test (α = .05).

RESULTS

Group D showed lowest strength (1.42 ± 0.23 MPa) and differed significantly (P < .001) from Group M (2.71 ± 0.45 MPa) and Group P (2.47 ± 0.41 MPa). There was no significant difference (P = .34) between Group M and Group P. The failure modes for Groups M and Group P were mainly cohesive, while Group D showed adhesive failure.

CONCLUSIONS

The retention strength of zirconia crowns was improved with Multilink Speed and Panavia V5 cement systems, while the use of the Duo-Link Universal cement system only showed half of those retention strength values.

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

The Scientific Investigation Committee of the American Academy of Restorative Dentistry offers this review of the 2020 professional literature in restorative dentistry to inform busy dentists regarding noteworthy scientific and clinical progress over the past year. Each member of the committee brings discipline-specific expertise to this work to cover this broad topic. Specific subject areas addressed include prosthodontics; periodontics, alveolar bone, and peri-implant tissues; implant dentistry; dental materials and therapeutics; occlusion and temporomandibular disorders (TMDs); sleep-related breathing disorders; oral medicine and oral and maxillofacial surgery; and dental caries and cariology. The authors focused their efforts on reporting information likely to influence day-to-day dental treatment decisions with a keen eye on future trends in the profession. With the tremendous volume of dentistry and related literature being published today, this review cannot possibly be comprehensive. The purpose is to update interested readers and provide important resource material for those interested in pursuing greater detail. It remains our intent to assist colleagues in navigating the extensive volume of important information being published annually. It is our hope that readers find this work useful in successfully managing the dental patients they encounter.

Effect of zirconia etching solution on the shear bond strength between zirconia and resin cement

STATEMENT OF PROBLEM

The bond between resin cement and zirconia is essential to the long-term retention of a zirconia crown. However, it is unclear if the existing methods provide a long-term bond between resin cement and zirconia.

PURPOSE

The purpose of this in vitro study was to evaluate the effects of a zirconia etching solution on the shear bond strength between zirconia and resin cement.

MATERIAL AND METHODS

Sixty yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) disks (Ø8×5 mm) were divided into 4 groups (n=15). Each group was then treated with 1 of the following methods: airborne-particle abraded with 50-μm Al₂O₃ (AA); etched with zirconia etching solution (ZES); airborne-particle abraded with 50-μm Al₂O₃ and then etched with ZES (AA-ZES); etched with ZES and then airborne-particle abraded with 50-μm Al₂O₃ (ZES-AA). Sixty composite resin cylinders (Ø2.3×2.4 mm) were luted to the zirconia disks with a self-adhesive resin cement under constant load and then light-polymerized for 40 seconds. Specimens were stored in a 37 °C incubator in distilled water for 24 hours and then thermocycled for 1000 cycles between 5 °C and 55 °C. A universal testing machine with a crosshead speed of 0.5 mm/min was used to measure the shear force (N). The shear bond strength (MPa) was then calculated. One-way ANOVA was used to compare the mean shear bond strength among the groups (α=.05). The failure mode was evaluated by using light microscopy at ×90 magnification and categorized as an adhesive, cohesive, or mixed failure.

RESULTS

Mean ±standard deviation shear bond strength for AA, ZES, AA-ZES, and ZES-AA groups were 9.9 ±2.6, 8.9 ±2.9, 9.6 ±3.9, and 11.0 ±2.3 MPa, respectively. There was no significant difference among the treatment groups (P>.05).

CONCLUSIONS

A zirconia etching solution did not significantly improve the shear bond strength between zirconia and resin cement compared with airborne-particle abrasion with Al₂O₃.

Effect of 10-Methacryloyloxydecyl Dihydrogen Phosphate Concentrations in Primers on Bonding Resin Cements to Zirconia

PURPOSE

To investigate the effect of 10-methacryloyloxydecyl dihydrogen phosphate (MDP) concentration in primers on bonding of resin cements to zirconia.

MATERIALS AND METHODS

Highly translucent partially stabilized zirconia plates were bonded to stainless steel rods using one of 3 commercially available resin cements without adhesive functional monomers and without air-abrasion. Ten specimens of each resin cement group were pretreated with one of the primers containing 0.5, 1.0, 2.0, 3.0, 4.0, or 5.0 wt% of MDP dissolved in ethanol, or one of 3 commercial ceramic primers containing MDP and silane coupling agents. Untreated specimens were used as controls. The tensile bond strength was measured after 24 hours (TC0) and after thermal cycling at 4 to 60°C (TC3,500). Data were statistically analyzed using 1- or 2-way ANOVA and Tukey-Kramer post-hoc tests (α = 0.05).

RESULTS

The mean tensile bond strength in the unpretreated group was significantly lower compared to that in the pretreated groups with MDP-containing primers regardless of the resin cement used (p < 0.0001). The tensile bond strengths increased with an increase in MDP concentration from 0.5 wt% to 3.0 wt% or 4.0 wt%. Pretreated groups with 4.0-wt% MDP-containing primer showed significantly higher tensile bond strengths than pretreated groups with commercial ceramic primers regardless of the resin cement used and thermal cycling (p < 0.0001).

CONCLUSION

Primers containing 4.0-wt% MDP achieved higher bond strengths of resin cements to zirconia compared to commercial ceramic primers containing MDP and silane coupling agent.

Effects of 10-MDP Based Primer on Shear Bond Strength between Zirconia and New Experimental Resin Cement

To date, numerous materials in the dental field are marketed to ensure stable adhesive cementation of zirconia ceramics (Y-TZP). The aims of this study were to assess the shear bond strength of the new experimental cement Surgi Dual Flo' Zr to Y-TZP compared to Panavia V5 cement, and to evaluate the effect of 10-MDP (10-methacryloyloxydecyl dihydrogen phosphate) containing primer on their bond strength. Twenty composite cylinders and Y-TZP disks were adhesively luted and divided into four groups based on cement type used and application or not of 10-MDP. The groups (n = 5 each) were S 10MDP (Surgi Dual Flo' Zr with 10-MDP); S no 10MDP (Surgi Dual Flo' Zr without 10-MDP); P 10MDP (Panavia V5 with 10-MDP); P no 10MDP (Panavia V5 without 10-MDP). Maximum load resistance (ML) and shear bond strength (SBS) were tested and mode of failure qualitative documented via scanning electron microscopy. The data were analyzed with one-way ANOVA, Holm-Sidak method, and Bayesian analysis. ML and SBS were significantly higher in S 10MDP than in S no 10MDP; and in P 10MDP than in P no 10MDP (p < 0.05). No significant differences were found between S 10MDP and P 10MDP; S no 10MDP and P no 10MDP (p > 0.05). Cohesive, adhesive, and mixed failure occurred among the groups. Bond strength between the experimental resin-based cement and Y-TZP was adequate for clinical application when 10-MDP was added. 10-MDP containing primer was effective improving the bond strength to Y-TZP more than the different type of resinous cement.