Self-Adhesive Resin Cements - Adhesive Performance To Indirect Restorative Ceramics
Self-Adhesive Resin Cements - Adhesive Performance To Indirect Restorative Ceramics
Self-Adhesive Resin Cements - Adhesive Performance To Indirect Restorative Ceramics
Purpose: To evaluate the bonding performance of self-adhesive resin cements to zirconia and lithium disilicate in
self- and dual-curing modes before and after thermocycling.
Materials and Methods: Rectangular bars (3 mm high, 3 mm wide, 9 mm long) were manufactured from zirco-
nia (Vita In-Ceram YZ for inLab, VITA) and lithium disilicate blocks (IPS e.max Press, Ivoclar Vivadent) (n = 240
per material). Zirconia bars were sandblasted (35 μm Al2O3, 1.5 bar pressure). Lithium disilicate bars were HF
etched (20 s, IPS Ceramic Etching Gel, Ivoclar Vivadent) and silanized with ESPE Sil (3M ESPE). Forty bars of
zirconia were luted in twos perpendicular to each other as were 40 bars of lithium disilicate using RelyX Unicem
Automix 2 (3M ESPE), G-Cem LinkAce (GC Europe) or Maxcem Elite (Kerr) in self- or dual-curing mode. Half of
the specimens from each material were submitted to tensile bond strength (TBS) testing after 24-h storage in
distilled water at 37°C, and half underwent TBS testing after thermocycling (5000 cycles, 5°C/55°C, 30-s dwell
time). Bond strength values for each bonding substrate were analyzed using one-way ANOVA (Student-Newman-
Keuls, α = 0.05).
Results: On zirconia, dual-curing resulted in significantly (p < 0.05) higher tensile bond strengths compared
to self-curing, with the exception of RelyX Unicem 2 after thermocycling. Thermocycling significantly (p < 0.05)
reduced the tensile bond strength of Maxcem Elite to zirconia in both curing modes. The TBS of self-adhesive
cements to lithium disilicate showed no significant (p > 0.05) difference between the different curing modes and
after thermocycling.
Conclusion: For most of the investigated self-adhesive cements, bond strengths to zirconia were increased by
dual curing; this was not true for lithium disilicate. For luting on zirconia with self-adhesive cements, dual curing
is strongly recommended in clinical situations.
Keywords: self-adhesive resin cements, tensile bond strength, zirconia, lithium disilicate, thermocycling
J Adhes Dent 2014; 16: 541–546. Submitted for publication: 24.05.14; accepted for publication: 09.10.14
doi: 10.3290/j.jad.a33201
were light cured for 40 s from each side (Elipar Trilight, 3M Table 2 Mean tensile bond strength in MPa (standard
ESPE, 750 mW/cm2) and the other half was left to self- deviation) of materials under investigation on zirconia
cure under exclusion of light. All specimens were stored for self- and dual-curing mode, before and after thermo-
for 24 h in distilled water at 37°C. After storage, half of cycling
the specimens (n = 10 per material and curing mode)
were immediately submitted to tensile bond strength Material Curing Tensile bond strength in MPa
testing and the other half (n = 10 per material and curing mode
mode) after TC (5000 cycles, 5°C/55°C, 30-s dwell time). 24 h Thermocycling
40
35 after 24 h
after
Tensile bond-strength [MPa]
30
thermocycling
25
20
15
10
5
Fig 2 Mean tensile bond
strength (MPa) and stan-
0 dard deviation on zirconia
Self-curing Dual-curing Self-curing Dual-curing Self-curing Dual-curing
for self- and dual-curing
RelyX Unicem 2 G-Cem LinkAce Maxcem Elite modes, before and after
thermocycling.
Table 3 Mean tensile bond strength in MPa (standard respective of the curing mode or thermocycling status)
deviation) of materials under investigation on lithium as well as between the respective groups (eg, within the
disilicate for self- and dual-curing mode, before and self-curing groups, etc).
after thermocycling
40
35 24 h
Thermocycling
25
20
15
10
5
Fig 3 Mean tensile bond
strength (in MPa) and
standard deviation on lith- 0
Self-curing Dual-curing Self-curing Dual-curing Self-curing Dual-curing
ium disilicate for self- and
dual-curing modes, before RelyX Unicem 2 G-Cem LinkAce Maxcem Elite
and after thermocycling.
The first null hypothesis, ie, that the curing mode has For cementation to zirconia without separate primer
no influence on bond strength, must be partially rejected application before luting, bonding efficacy depends en-
for bonding to zirconia and accepted for the lithium dis- tirely on the luting agent and its mechanical stability.
ilicate substrate. The measured TBS values on zirconia In order to challenge the mechanical stability, thermal
were affected most by the selected curing mode. Dual- loading was performed on the adhesive interface. Due to
cured specimens had significantly higher bond strength their acid-functionalized monomers, self-adhesive resin
values than those that were only self-cured when zirconia cements have a low pH upon mixing, allowing them to
was used as the substrate (Table 2). On lithium disilicate, demineralize enamel and dentin, attach to the hydroxyapa-
dual-cured specimens had no statistically significant higher tite calciumions, and create a bond to the tooth via ion-
bond strength values than self-cured specimens (Table 3). ized phosphoric-acid methacrylates.10,15 Studies have
It is known that dual curing of self-adhesive resin cements demonstrated that the long-term mechanical stability of
results in a higher degree of conversion18 and extent of self-adhesive resin cements in self-curing mode is sig-
polymerization.6 Sufficient curing is crucial to achieve ad- nificantly influenced by their pH-neutralization behavior.20
equate physical and mechanical material properties,11 in That study showed that materials with insufficient pH
this case, higher cohesive strength of the self-adhesive neutralization, such as Maxcem Elite, experienced a sig-
luting agents and thus higher bond strength.3 Phosphoric nificant decrease in flexural strength after thermocycling,
acid-functionalized monomers are suspected to compete whereas materials with better pH neutralization, eg, RelyX
for free radicals and interfere with polymerization,1 result- Unicem 2, showed no decrease in mechanical proper-
ing in a low degree of conversion18 and extent of poly- ties. This correlates with the findings of this study, in
merization.6 For self-adhesive resin cements in self-curing which the TBS of Maxcem Elite to zirconia dropped signifi-
mode, a significantly lower degree of conversion and lower cantly after thermocycling from 14.54 MPa to 3.89 MPa
bond strength has been shown in the recent literature,2,3,16 in self-curing mode and from 19.89 MPa to 14.21 MPa in
which was confirmed by the results of the present study. dual-curing mode. In contrast, no significant differences
On zirconia, the second null hypothesis must be re- in TBS after thermal loading could be shown for RelyX
jected, as significant differences between the bonding Unicem 2 and G-Cem LinkAce. Therefore, the null hypoth-
ability of the self-adhesive cements were observed. In esis that thermocycling has no significant influence on
both the self-curing and dual-curing mode after 24 h, G- bond strength has to be partially rejected for luting to
Cem LinkAce achieved 21.45 MPa, the significantly high- zirconia. For the lithium disilicate ceramic, thermocycling
est mean value compared to RelyX Unicem 2 and Maxcem had no significant influence on bond strength. Luting to
Elite. The bonding ability of self-adhesive resin cements is lithium-disilicate specimens was performed using a sepa-
mainly based upon phosphoric acid-functionalized mono- rate ethanol-based 3-methacryloxypropyltrimethoxy silane
mers.10 Based on the results, it can be presumed that silane-coupling agent. This methacrylate-free primer was
material chemistry plays a central role in the 24-h efficacy employed to avoid undesirable interactions, such as inhi-
of bonding to zirconia. Such differences are difficult to bition of the condensation reaction between the silanol of
discuss, as the chemical formulations are protected by the primer and the ceramic.7 In this case, the primary link
manufacturers (Table 1). between the bonding substrate and the luting agent is the
silanized ceramic surface and not the self-adhesive resin, 5. Blatz M, Phark J-H, Özer F, Mante F, Saleh N, Bergler M, Sadan A. In
vitro comparative bond strength of contemporary self-adhesive resin ce-
so that the bonding to the ceramic is primarily generated ments to zirconium oxide ceramic with and without air-particle abrasion.
by the silane. Differences in the bonding performance of Clin Oral Investig 2010;14:187-192.
the different materials and the mechanisms discussed 6. Cadenaro M, Navarra CO, Antoniolli F, Mazzoni A, Di Lenarda R, Ruegge-
berg FA, Breschi L. The effect of curing mode on extent of polymeriza-
above leading to them are thereby attenuated. This is tion and microhardness of dual-cured, self-adhesive resin cements. Am
probably the reason that no significant differences were J Dent 2010;23:14-18.
observed in either curing mode after 24 h or thermocycling 7. Chen L, Shen H, Suh BI. Effect of incorporating BisGMA resin on the
among different cements. Therefore, the second null hy- bonding properties of silane and zirconia primers. J Prosthet Dent
2013;110:402-407.
pothesis that the self-adhesive cement used does not 8. Chen L, Suh BI, Brown D, Chen X. Bonding of primed zirconia ceramics:
influence bond strength to lithium disilicate is accepted. evidence of chemical bonding and improved bond strengths. Am J Dent
The statistically nonsignificant decrease in bond strength 2012;25:103-108.
after thermocycling can be attributed in part to the loss 9. Ferracane JL, Mitchem JC, Condon JR, Todd R. Wear and marginal
breakdown of composites with various degrees of cure. J Dent Res
of mechanical stability of the cements discussed above. 1997;76:1508-1516.
A degradation of the siloxane network resulting in loss of 10. Ferracane JL, Stansbury JW, Burke FJ. Self-adhesive resin cements
bond strength13 between the lithium disilicate and the – chemistry, properties and clinical considerations. J Oral Rehabil
2011;38:295-314.
self-adhesive resin cement does not seem likely.
11. Li J, Li H, Fok AS, Watts DC. Multiple correlations of material param-
eters of light-cured dental composites. Dent Mater 2009;25:829-836.
12. Lohbauer U, Zipperle M, Rischka K, Petschelt A, Müller FA. Hydroxyl-
CONCLUSION ation of dental zirconia surfaces: characterization and bonding poten-
tial. J Biomed Mater Res B Appl Biomater 2008;87:461-467.
13. Lung CYK, Matinlinna JP. Aspects of silane coupling agents and surface
Within the limits of this study, it can be concluded that conditioning in dentistry: an overview. Dent Mater 2012;28:467-477.
self-adhesive resin cements effectively bond to zirconia 14. Madruga FC, Ogliari FA, Ramos TS, Bueno M, Moraes RR. Calcium hy-
without the need for a separate priming procedure, mak- droxide, pH-neutralization and formulation of model self-adhesive resin
cements. Dent Mater 2013;29:413-418.
ing them an attractive alternative for routine luting of
15. Park JW, Ferracane JL. Water aging reverses residual stresses in hydro-
zirconia crowns. However, the resulting bond strength to philic dental composites. J Dent Res 2014;93:195-200.
zirconia varies among the different brands of self-adhe- 16. Sabatini C, Patel M, D’Silva E. In vitro shear bond strength of three self-
sive cements. This was not observed for luting to lithium adhesive resin cements and a resin-modified glass ionomer cement to
various prosthodontic substrates. Oper Dent 2012;38:186-196.
disilicate. As the selected curing mode had the greatest
17. Van Landuyt KL, Nawrot T, Geebelen B, De Munck J, Snauwaert J, Yo-
influence on the measured bond strengths to zirconia, shihara K, Scheers H, Godderis L, Hoet P, Van Meerbeek B. How much
light curing of self-adhesive resin cements is strongly do resin-based dental materials release? A meta-analytical approach.
Dent Mater 2011;27:723-747.
recommended whenever it is clinically possible, in order
18. Vrochari AD, Eliades G, Hellwig E, Wrbas K-T. Curing efficiency of four self-
to achieve reliable, stable long-term bonding. etching, self-adhesive resin cements. Dent Mater 2009;25:1104-1108.
19. Vrochari AD, Eliades G, Hellwig E, Wrbas KT. Water sorption and solubil-
ity of four self-etching, self-adhesive resin luting agents. J Adhes Dent
2010;12:39-43.
ACKNOWLEDGMENTS
20. Zorzin J, Petschelt A, Ebert J, Lohbauer U. pH neutralization and influ-
The manufacturers supplied the materials examined. ence on mechanical strength in self-adhesive resin luting agents. Dent
Mater 2012;28:672-679.
REFERENCES
1. Adusei G, Deb S, Nicholson JW, Mou L, Singh G. Polymerization behav-
ior of an organophosphorus monomer for use in dental restorative ma- Clinical relevance: As the selected curing mode
terials. J Applied Polymer Sci 2003;88:565-569. had the greatest influence on the measured bond
2. Aguiar T, Pinto C, Cavalli V, Nobre-Dos-Santos M, Ambrosano G, Math- strengths to zirconia, light curing of self-adhesive
ias P, Gianinni M. Influence of the curing mode on fluoride ion release
of self-adhesive resin luting cements in water or during pH-cycling regi- resin cements is strongly recommended whenever
men. Oper Dent 2012;37:63-70. it is clinically possible, in order to achieve reliable,
3. Aguiar TR, Di Francescantonio M, Ambrosano GMB, Giannini M. Effect stable long-term bonding. Furthermore, clinicians
of curing mode on bond strength of self-adhesive resin luting cements
to dentin. J Biomed Mater Res B Appl Biomater 2010;93B:122-127. must take into account that bond strength to zirconia
4. Amaral M, Belli R, Cesar PF, Valandro LF, Petschelt A, Lohbauer U. The varies among the different brands of self-adhesive ce-
potential of novel primers and universal adhesives to bond to zirconia. J ments.
Dent 2014;42:90-98.