ReviewAspects of bonding between resin luting cements and glass ceramic materials
Introduction
All-ceramic materials are well known for the esthetic ability of imitating tooth color. Recent developments in ceramic restoration fabrication techniques came about with ceramics possessing higher strength and toughness [1], making it possible for wider applications in dentistry such as veneers, inlays/onlays or dental implants [2], [3], [4].
Nowadays, there are increasing cases where the retention of restorations is reliant on bonding, e.g. resin-bonded bridges. Hence, the quality of bonding is of increasing importance, and is a dominant factor required for the long-term success of glass ceramic restorations. Compared with traditional cements such as polycarboxylate or glass ionomer cement, resin luting cements were introduced to aid all-ceramic restoration retention [5]. Resin cements not only provide stronger and more durable bonding between ceramics and teeth, but can also achieve better esthetic outcomes and maintain higher ceramic strength [6].
Ceramics in dentistry can be generally classified into “oxide ceramics” and “glass ceramics” based on the chemical composition. Oxide ceramics are defined as a group of ceramics containing not more than 15% silica with little or no glass phase [7]. They can be subclassified into aluminium-oxide/alumina ceramics, including glass-infiltrated alumina ceramics, densely sintered alumina ceramic systems, and zirconium-oxide/zirconia ceramics, including glass-infiltrated and densely sintered zirconia ceramic systems. Because of their stable chemical structure, oxide ceramics have significantly improved mechanical properties [8] and can be called “high strength core ceramics”. However, the surface cannot be etched by hydrofluoric acid (HF), which is the usual chemical means to condition the surface to obtain micro-mechanical adhesion. These oxide ceramics are known as “acid-resistant ceramics” [9]. Nevertheless, caution should be drawn in using such terminology as recent studies have only tested this type of ceramic with HF but not other acids.
It is accepted that adhesion between ceramics and resin cements is provided by two major mechanisms: micromechanical attachment and chemical bonding. Micromechanical attachment can be created by acid etching [10] and/or sandblasting [11], whilst a silane coupling agent provides a chemical bond [12]. Various glass ceramics differ in chemical conformation and microstructure, so it might be necessary to establish bonding procedures according to the glass ceramic type.
The ceramic and resin cement bond is subjected to a complex environment in the oral cavity being influenced by several extrinsic factors such as temperature change, saliva, daily food and drink intake, biting force and other habits. Consequently, laboratory testing should simulate these variables to enable the development of superior materials and surface preparation methods that provide long-term durable bond strengths in the oral environment.
The aim of this systematic review was to evaluate laboratory studies investigating the resin luting cement (resin cement) bond to dental ceramics.
Section snippets
Search strategy
A search of the Pubmed library, Medline, Embase and the Cochrane library was performed on the literature available from 1972 to April 18, 2012. The keywords used were: ‘bond’, ‘bonding’, ‘adhesive’, ‘adhesion’, ‘luting’, ‘resin cement’, ‘resin composite’, luting composite’, ‘luting agent’, ‘luting resin’, ‘porcelain’, ‘ceramic’, ‘ceramics’. English and Chinese papers were included in this search.
Articles reviewed and data extraction
The included articles were independently reviewed by two reviewers. Inclusion criteria were studies
Results
After searching and screening the database, a total of 83 articles were included. Owing to the high heterogeneity of studies regarding preparation of materials, methods of testing and outcome variables, it was not possible to analyze the data quantitatively. Articles are summarized in Section 4 concerning factors related to the ceramic-resin bond.
Ceramics
Glass ceramics, also termed silica-based ceramics [13], [14], are a group of materials that have been widely used for all-ceramic restorations since the 1970s. These can be further classified as feldspathic, leucite-reinforced, fluormica glass or lithium disilicate ceramic. HF etching has a distinctive effect on the surface of these ceramics creating a uniformly porous surface [9]. This distinctive effect has made this group of glass ceramics dominate resin-bonded ceramic restoration
Conclusion
It has been realized that the bond between glass ceramics and resin cements are one of the key factors to long-term clinical success. Intense research activity has brought many contributions to the understanding on ceramic–resin bonding in the past few years. Based on scientific and clinical evidence, it seems to be clear that HF etching and silanization are necessary for the surface treatment of a glass ceramic restorations. However, the optimal bonding procedure remains controversial. More
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