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.

MDP-salts as an adhesion promoter with MDP-primers and self-adhesive resin cement for zirconia cementation.

PURPOSE: To evaluate the effect of zirconia priming with MDP-Salt before MDP containing primers and self-adhesive cement on the shear bond strength. MATERIALS AND METHODS: Fully sintered high translucent zirconia specimens (n = 120) were assigned into 2 groups (n = 60 each): Control (No Pretreatment) and Methacryloyloxydecyl dihydrogen phosphate salt (MDP-Salt) pretreated. Each group was divided into 3 subgroups (n = 20) according to cementation protocol: 1) MDP + Silane primer and conventional resin cement, 2) MDP+ Bisphenyl dimethacrylate (BPDM) primer and conventional resin cement, and 3) MDP containing self-adhesive resin cement. Shear bond strength (SBS) was measured after 10,000 thermocycling. Contact angle was measured for tested groups. Surface topography was assessed using a 3D confocal laser scanning microscope (CLSM). Weibull analysis was performed for SBS and one-way ANOVA for contact angle and surface topography measurements (α = 0.05). RESULTS: The use of MDP-Salt significantly improved the SBS (p < .05) for all tested subgroups. Self-adhesive cement showed an insignificant difference with MDP + Silane group for both groups (p > .05). MDP + BPDM showed a significantly lower characteristic strength compared to self-adhesive resin cement when both were pretreated with MDP-Salt. No difference between all tested groups in the surface topographic measurements while MDP-Salt showed the highest contact angle. CONCLUSION: MDP-Salt pretreatment can improve bonding performance between zirconia and MDP containing products.

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.

Influence of Primers and Additional Resin Layer on Zirconia Repair Bond Strength.

PURPOSE: To evaluate the influence of alloy/zirconia primer and 10-methacryloyloxydecyl dihydrogen phosphate (MDP)-containing resin layer treatments on the shear bond strength (SBS) of composite resin to zirconia after aging. MATERIALS AND METHODS: Sixty zirconia (Y-TZP) blocks were air-abraded (35-µm Al2 O3 ) and divided into 6 experimental groups (n = 10) in terms of primer/resin layer as follows: (1) control, without any primer or resin; (2) AP, Alloy Primer; (3) ZPP, Z-Prime Plus; (4) PL/ZPP, Z-Prime Plus with light polymerization; (5) AP+SEB, Alloy Primer along with light-cured bonding resin of a self-etch adhesive system (SE Bond); and (6) ZPP+SEB, Z-Prime Plus with SE Bond. After composite resin placement and light polymerization, the specimens were stored in distilled water (37°C for 4 months) and thermal-cycled for 6000 cycles. The SBS was tested with a universal testing machine. Statistical analysis of the SBS data was performed with one-way ANOVA, followed by HSD Tukey test (α = 0.05). RESULTS: There were significant differences between the groups (p < 0.001, F = 116.5). All the groups revealed significantly higher SBS than the control (p < 0.001). ZPP+SEB group exhibited the highest SBS (16.14 ± 2.52 MPa) and AP group the lowest SBS (7.00 ± 1.97 MPa) among experimental groups; both had significant differences with the other groups (p < 0.001). There were no significant differences between ZPP, PL/ZPP, and AP+SEB groups (p > 0.05). CONCLUSIONS: The bond strength between zirconia ceramic and composite resin was affected by different primers/resin layer. Applying an MDP-containing resin layer along with both primers resulted in significant enhancement of SBS. This improvement for Z-Prime Plus was significantly higher than that of Alloy Primer.

The effect of a zirconia primer on the shear bond strength of Y-TZP ceramic to three different core materials by using a self-adhesive resin cement.

AIM: Considering the importance of bond strength of zirconia ceramic to different core materials, this study aimed to evaluate the effect of a new zirconia primer, a mixture of organophosphate and carboxylic acid monomers, on the bond strength of zirconia to three core materials cemented with a self-adhesive resin cement. MATERIALS AND METHODS: The study was done on 36 disk-shaped zirconia specimens in the case (receiving new zirconia primer) and control groups (n = 18) and three core material subgroups (n = 6) (amalgam, nickel-chromium [Ni-Cr], and composite resin). A self-adhesive resin-based luting agent bonded the two parts together. The shear bond strength was tested and the facture modes were determined. Two-way ANOVA and Tukey's honestly significant difference tests were used for data analyses (α = 0.05). RESULTS: Zirconia primer could not significantly increase the bond strength of zirconia ceramic to different core materials (P = 0.754). Composite resin and amalgam cores showed significantly higher bond strength than Ni-Cr core (P = 0.001). On using zirconia primer, 100% of failures of composite resin cores were cohesive inside the core material, 75% in amalgam core and 100% in Ni-Cr core were adhesive. CONCLUSIONS: The use of new zirconia primer based on organophosphate/carboxylic acid monomers could not enhance the bond strength of zirconia ceramic to different core materials. The bond strength of zirconia to amalgam and composite resin cores was higher than that to Ni-Cr core material.

Effect of metal type and surface treatment on shear bond strength of resin cement (in vitro study).

BACKGROUND: Resin-bonded fixed partial dentures appeared to prevent the excessive preparation of dental tissue. Investigation of surface treatments to improve the bond of resin cements to metals may contribute to the longevity of these restorations. Due to the potential lack of ideal preparation form, the type of alloy and its surface pretreatment may have clinically relevant correlations with the retentive strength of castings to minimally retentive preparations. AIM: The aim of this search is to study the bonding resin cement strength to different types of the metal alloy due to the surface treatment. PURPOSE: Evaluate the effects of two different surface treatments on shear bond strength (SBS) between a palladium-silver alloy (Pb-Ag) and commercially pure titanium (CP Ti) cast alloy with resin luting cements. MATERIALS AND METHODS: A total of 120 cylinders having 5 mm in diameter and 4 mm in height were divided into two different main groups of metal type: 60 cylinders cast from CP Ti Grade I (Tritan - Reintitan - Germany-Dentaurum) as a base metal and 60 cylinders cast from Pb-Ag (Status-Yamakin, Japan) as a noble metal. 30 cylinders from each type were embedded in acrylic resin, and the rest were left without embedded in acrylic resin. All of the cylinders were smoothed with silicon carbide papers and sandblasting with 50-µm aluminum oxide. Specimens of each metal type were divided into two subgroups, which received one of the following luting techniques: (1) Multilink (Ivoclar Vivadent), (2) Multilink (Ivoclar Vivadent) plus metal zirconia primer (MZP). Every two cylinders from the same metal type and surface treatment were bonded to each other. All specimens were stored in distilled water at 37°C for 24 h and then thermal cycled (500 cycles, 5-55°C). After thermal cycling, the specimens were stored in 37°C distilled water for an additional 24 h before being tested in shear strength. Data (MPa) were analyzed using T-s tests to study the significance of various - means among groups and perform a comparison between each two groups of them. RESULTS: The T-s tests indicated significant effect of combination of the sandblasting technique (aluminum oxide particles 50 µm) with the application of primer MZP before using resin cement (P < 0.05) independent of the metal type used. The metal type did not significantly affect SBS for any of the compared surface pretreatments. CONCLUSION: Metal primer application significantly enhanced SBS to base and a noble metal. No significant differences in shear strength were found between alloys.

An in vitro comparison of shear bond strength of zirconia to enamel using different surface treatments.

PURPOSE: The purpose of this in vitro study was to compare the shear bond strength of an airborne-particle abraded zirconia, an acid-etched zirconia (Piranha solution), an Alloy Primer treated zirconia, and a silaned zirconia to enamel, all bonded with a phosphate-methacrylate resin luting agent. MATERIALS AND METHODS: Seventy extracted intact human molars were collected, cleaned, and mounted in autopolymerizing acrylic resin, with the experimental surface of the teeth exposed. The specimens were randomly divided into seven groups of zirconia specimens (4 mm diameter, 2 mm thick). Group 1: Airborne-particle abrasion; group 2: Airborne-particle abrasion and Z-PRIME Plus; group 3: Airborne-particle abrasion and alloy primer; group 4: Piranha solution 7:1; group 5: Piranha solution 7:1 and Z-PRIME Plus; group 6: Piranha solution 7:1 and Alloy primer; group 7: CoJet and silane. All specimens were luted with a phosphate-methacrylate resin luting agent (Panavia F2.0) and stored in distilled water for 1 day, then thermocycled (5°C and 55°C) for 500 cycles and tested for shear bond strength (SBS), measured in MPa, with a universal testing machine at a 0.55 mm/min crosshead speed. All specimens were inspected under a scanning electron microscope to determine mode of failure. The mean values and standard deviations of all specimens were calculated for each group. A one-way ANOVA was performed, and multiple pairwise comparisons were then completed with post hoc Tukey test (alpha = 0.05). RESULTS: The airborne-particle abrasion and Z-PRIME Plus group resulted in a significantly higher SBS than the other groups (21.11 ± 6.32 MPa) (p < 0.001). The CoJet and silane group (15.99 ± 8.92 MPa) and airborne-particle abrasion and alloy primer group (11.07 ± 4.34 MPa) showed high shear bond strength but not statistically significant from the airborne-particle abrasion group (14.23 ± 5.68 MPa). Failure mode was predominately mixed in groups 1, 2, 3, and 7 with islands of retained resin on the zirconia and enamel surfaces; however, groups 4, 5, and 6 showed mostly adhesive failures, which left the zirconia surface free of the adhesive materials. No cohesive failures of the substrates (ceramic, resin, or enamel) were observed. CONCLUSION: Airborne-particle abrasion followed by the application of a zirconia primer produced the highest bond strength to enamel. Therefore, it can be recommended as a promising surface treatment method to achieve a durable bond to densely sintered zirconia ceramics.

Evaluation of Shear Bond Strengths of 3D Printed Materials for Permanent Restorations with Different Surface Treatments.

The development of high-filled 3D printing resin necessitates a bonding protocol for dental indirect restorations to achieve optimal bond strength after cementation. This study evaluates shear bond strengths of high-filler 3D printed materials for permanent restorations with various surface treatments. Rodin Sculpture 1.0 (50% lithium disilicate fillers) and 2.0 Ceramic Nanohybrid (>60% zirconia and lithium disilicate fillers) were tested, with Aelite All-Purpose Body composite resin as control. Samples were prepared, post-cured, and sandblasted with alumina (25 µm). Surface roughness was analyzed using an optical profilometer. Two bonding protocols were compared. First, groups were treated with lithium disilicate silane (Porcelain Primer) or zirconia primer (Z-Prime Plus) or left untreated without a bonding agent. Beam-shaped resin cement (DuoLink Universal) specimens were bonded and stored in a 37 °C water bath. Second, additional sets of materials were coated with a bonding agent (All-Bond Universal), either followed by silane application or left untreated. These sets were then similarly stored alongside resin cement specimens. Shear bond tests were performed after 24 h. SEM images were taken after debonding. One-Way ANOVA and post hoc Duncan were performed for the statistical analysis. Rodin 1.0 exhibited increased adhesive failure with silane or zirconia primer coating, but significantly improved bond strengths with bonding agent application. Rodin 2.0 showed consistent bond strengths regardless of bonding agent application, but cohesive failure rates increased with bonding agent and filler coating. In all groups, except for Rodin 1.0 without bonding agent, silane coating increased cohesive failure rate. In conclusion, optimal shear bond strength for high-filler 3D printing materials can be achieved with silane coating and bonding agent application.

Are Universal Adhesives Effective for Bonding to Zirconia in the Long Term?

Background: The bond capacity of universal adhesives should be comparable to a specific primer for zirconia. Thus, this study evaluated the bond strength to zirconia of four universal adhesives and a zirconia primer over long-term storage. Materials and Methods: The surfaces of 75 samples of zirconia were sandblasted with 50 µm aluminum oxide particles and then divided into groups (n = 15): G1 - Single Bond Universal (SBU); G2 - All Bond Universal; G3 - Peak Universal Bond; G4 - Ambar Universal (AU), and G5 - Z-Prime Plus (ZP). A cone of resin composite was constructed on the applied materials. The samples were submitted to a tensile bond strength test after 24 h using a universal testing machine. Then, the remaining materials were removed from the sample surfaces, and the surfaces were polished and sandblasted again as previously described to obtain the same groups. These new samples were stored in distilled water at 37°C for 12 months and then submitted to a tensile bond strength test. The data were analyzed by two-way analysis of variance and Tukey's test (α =0.05). Results: The material factor (P = 0.001) and the storage factor (P = 0.001) were significant, and the interaction was not significant (P = 0.117). According to Tukey's test, bond strength mean values (in MPa) followed by distinct letters were significantly different. After 24 h, G5 = 21.12 A, G1 = 20.55 A, G4 = 19.19 AB, G2 = 14.22 B, and G3 = 8.44 C. After 12 months, G1 = 7.37 A, G5 = 5.61 AB, G4 = 4.97 B, G2 = 3.32 C, and G3 = 1.93 D. After 12 months of storage, all groups' bond strength significantly decreased. Conclusions: SBU and AU had bond strengths comparable to ZP after 24 h. No material resisted water degradation.

MDP Salts: A New Bonding Strategy for Zirconia.

Durable resin-ceramic adhesion may influence the clinical success of ceramic restorations, which has been one of the challenging issues in dentistry. The present study assessed the bond strength and chemical interaction of 10-methacryloxydecyl dihydrogen phosphate (MDP), MDP+silane, and MDP-salt primers to alumina-blasted zirconia ceramic by tensile bond strength test, surface elemental composition with x-ray photoelectron spectroscopy analysis, contact angle measurement, surface morphology with scanning electron microscopy, and surface topography with 3-dimensional confocal laser scanning microscope analyses. MDP-salt showed the highest tensile bond strength before and after thermocycling when compared with MDP and MDP+silane (P < 0.05). The measured contact angle values differed significantly (P < 0.001) in the order of MDP-salt > control (no chemical pretreatment) > MDP+silane > MDP. There was no difference in surface roughness (P = 0.317) and surface topography among all tested groups. Zirconia treated with MDP-salt showed phosphorus peaks in addition to zirconia and alumina peaks. MDP-salt has zirconia priming properties, which improves bonding performance to resin cement.

Effect of Non-Thermal Atmospheric Pressure Plasma (NTP) and Zirconia Primer Treatment on Shear Bond Strength between Y-TZP and Resin Cement.

The purpose of this study was to investigate the effect of non-thermal atmospheric pressure plasma (NTP) treatment on the sandblasting of mechanical method and zirconia primer of chemical method used to increase the bond strength between zirconia and resin cement. In this study, Y-TZP was divided into 4 groups according to the surface treatment methods as follows: Zirconia primer (Pr), NTP + Zirconia primer (NTP + Pr), Sandblasting + Zirconia primer (Sb + Pr), Sandblasting + NTP + Zirconia primer (Sb + NTP + Pr). Then, two types of resin cement (G-CEM LinkAce and Rely X-U200) were used to measure the shear bond strength (SBS) and they were divided into non-thermal cycling group and thermal cycling group for aging effect. Statistical analyses were performed using the Kruskal-Wallis test and Mann-Whitney U test. The result of the surface energy (SE), there was no significant difference among the groups (p > 0.05). As a result of the SBS test, the Sb + Pr group had a significantly higher SBS value than the other groups regardless of the resin cement type (p < 0.05), and the decrease rate after thermal cycling treatment was the lowest. On the other hand, the NTP + Pr group showed significantly lower SBS values than the other groups except for the case of using Rely X-U200 (p < 0.05), and the reduction rate after thermal cycling was the highest. The Sb + NTP + Pr group did not differ significantly from the Pr group (p > 0.05). Within the limitations of two successive studies, treatment with NTP after sandblasting used for mechanical bond strength showed a positive effect on initial SBS. However, when NTP was treated before the zirconia primer used for the chemical bond strength, it showed a negative effect on SBS compared to other treatment methods, which was noticeable after the thermal cycling treatment.

Comparison of bond strengths of ceramic brackets bonded to zirconia surfaces using different zirconia primers and a universal adhesive.

OBJECTIVES: The aim of this study is to compare the shear bond strengths of ceramic brackets bonded to zirconia surfaces using different zirconia primers and universal adhesive. MATERIALS AND METHODS: Fifty zirconia blocks (15 × 15 × 10 mm, Zpex, Tosoh Corporation) were polished with 1,000 grit sand paper and air-abraded with 50 µm Al2O3 for 10 seconds (40 psi). They were divided into 5 groups: control (CO), Metal/Zirconia primer (MZ, Ivoclar Vivadent), Z-PRIME Plus (ZP, Bisco), Zirconia Liner (ZL, Sun Medical), and Scotchbond Universal adhesive (SU, 3M ESPE). Transbond XT Primer (used for CO, MZ, ZP, and ZL) and Transbond XT Paste was used for bracket bonding (Gemini clear ceramic brackets, 3M Unitek). After 24 hours at 37°C storage, specimens underwent 2,000 thermocycles, and then, shear bond strengths were measured (1 mm/min). An adhesive remnant index (ARI) score was calculated. The data were analyzed using one-way analysis of variance and the Bonferroni test (p = 0.05). RESULTS: Surface treatment with primers resulted in increased shear bond strength. The SU group showed the highest shear bond strength followed by the ZP, ZL, MZ, and CO groups, in that order. The median ARI scores were as follows: CO = 0, MZ = 0, ZP = 0, ZL = 0, and SU = 3 (p < 0.05). CONCLUSIONS: Within this experiment, zirconia primer can increase the shear bond strength of bracket bonding. The highest shear bond strength is observed in SU group, even when no primer is used.

Alkaline nanoparticle coatings improve resin bonding of 10-methacryloyloxydecyldihydrogenphosphate-conditioned zirconia.

Creating an alkaline environment prior to 10-methacryloyloxydecyldihydrogenphosphate (MDP) conditioning improves the resin bonding of zirconia. The present study evaluated the effects of four alkaline coatings with different water solubilities and pH values on resin bonding of MDP-conditioned zirconia. Two alkaline nanoparticle coatings were studied in particular. Thermodynamics calculations were performed to evaluate the strengths of MDP-tetragonal phase zirconia chemical bonds at different pH values. Zirconia surfaces with and without alkaline coatings were characterized by scanning electron microscope (SEM)/energy dispersive spectrometer and Fourier transform infrared spectroscopy; alkaline coatings included NaOH, Ca(OH)2, nano-MgO, and nano-Zr(OH)4. A shear bond strength (SBS) test was performed to evaluate the effects of the four alkaline coatings on bonding; the alkaline coatings were applied to the surfaces prior to conditioning the zirconia with MDP-containing primers. Gibbs free energies of the MDP-tetragonal zirconia crystal model coordination reaction in different pH environments were -583.892 (NaOH), -569.048 [Ca(OH)2], -547.393 (MgO), and -530.279 kJ/mol [Zr(OH)4]. Thermodynamic calculations indicated that the alkaline coatings improved bonding in the following order: NaOH > Ca(OH)2 > MgO > Zr(OH)4. Statistical analysis of SBS tests showed a different result. SBSs were significantly different in groups that had different alkaline coatings, but it was not influenced by different primers. All four alkaline coatings increased SBS compared to control groups. Of the four coatings, nano-Zr(OH)4 and -MgO showed higher SBS. Therefore, preparing nano-Zr(OH)4 or -MgO coatings prior to conditioning with MDP-containing primers may potentially improve resin bonding of zirconia in the clinic.

Comparison of shear bond strength of orthodontic brackets using various zirconia primers.

OBJECTIVE: The aim of this study was to compare the shear bond strength (SBS) of orthodontic brackets bonded to zirconia surfaces using three different zirconia primers and one silane primer, and subjected to thermocycling. METHODS: We designed 10 experimental groups following the surface treatment and thermocycling. The surface was treated with one of the following method: no-primer (NP), Porcelain Conditioner (PC), Z-PRIME Plus (ZP), Monobond Plus (MP) and Zirconia Liner Premium (ZL) (n=20). Then each group was subdivided to non-thermocycled and thermocycled groups (NPT, PC, ZPT, MPT, ZLT) (n=10). Orthodontic brackets were bonded to the specimens using Transbond™ XT Paste and light cured for 15 s at 1,100 mW/cm(2). The SBS was measured at a 1 mm/min crosshead speed. The failure mode was assessed by examination with a stereomicroscope and the amount of bonding resin remaining on the zirconia surface was scored using the modified adhesive remnant index (ARI). RESULTS: The SBS of all experimental groups decreased after thermocycling. Before thermocycling, the SBS was ZL, ZP ≥ MP ≥ PC > NP but after thermocycling, the SBS was ZLT ≥ MPT ≥ ZPT > PCT = NPT (p > 0.05). For the ARI score, both of the groups lacking primer (NP and NPT) displayed adhesive failure modes, but the groups with zirconia primers (ZP, ZPT, MP, MPT, ZL, and ZLT) were associated with mixed failure modes. CONCLUSIONS: Surface treatment with a zirconia primer increases the SBS relative to no-primer or silane primer application between orthodontic brackets and zirconia prostheses.

The effect of ceramic primer on shear bond strength of resin composite cement to zirconia: a function of water storage and thermal cycling.

OBJECTIVES: The authors investigated the use of ceramic primers combined with self-adhesive resin composite cements on the shear bond strength (SBS) to zirconia and compared them with one conventional resin composite cement. METHODS: The authors divided zirconia substrates (N = 550) into three groups: RelyX Unicem Aplicap self-adhesive universal resin composite cement (3M ESPE, St. Paul, Minn.) (group A) (n = 220); G-CEM Capsule self-adhesive resin composite cement (GC Europe, Leuven, Belgium) (group B) (n = 220); and Panavia 21 with Clearfil Porcelain Bond Activator and Clearfil SE Bond primer (n = 110) (Kuraray Dental, Tokyo) used as a standard comparison (SC). The authors examined the self-adhesive resin composite cements without (0) and with (1) the use of a ceramic primer. They measured SBS initially (37°C for three hours), after water storage (37°C for one, four, nine, 16 or 25 days) and after thermal cycling (5°C and 55°C for 1,500, 6,000, 13,500, 24,000 or 37,500 cycles). The authors analyzed data by using descriptive statistics, the Mann-Whitney test, the Kruskal-Wallis test and a χ(2) test. RESULTS: Application of a ceramic primer did not result in a negative impact on SBS. Specimens in the A1 group (that is, RelyX Unicem Aplicap with ceramic primer) exhibited significantly higher SBS before and after water storage and thermal cycling compared with specimens that were not treated with a primer. The self-adhesive resin composite cements combined with ceramic primer exhibited similar or higher SBS values compared with those in the SC group at each aging duration (that is, water storage and thermal cycling). With respect to G-CEM Capsule, the authors observed a significantly positive effect of the primer after nine and 16 days' water storage and after one and four days' thermal cycling. They observed predominantly adhesive failures. CONCLUSIONS: Ceramic primer in combination with self-adhesive resin composite cement demonstrated a positive effect on SBS to zirconia and should be used for cementation. PRACTICAL IMPLICATIONS: Long-term adhesion to ceramic plays an important role in the longevity of dental restorations. Therefore, the authors recommend that clinicians use a ceramic primer when cementing zirconia restorations.