Self-adhesive Resin Cements: Adhesive Performance

to Indirect Restorative Ceramics

José Zorzina / Renan Bellib / Andrea Wagnerc / Anselm Petscheltd / Ulrich Lohbauere

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

a Research Assistant, Dental Clinic 1, Department of Restorative Dentistry

and Periodontology, Friedrich Alexander University Erlangen-Nürnberg, Erlan-
I n order to achieve bonding to tooth and restoration,
self-adhesive cements employ a complex chemistry
based on (meth)acrylate monomers containing carbox-
gen, Germany. Idea, hypothesis, performed the experiments and statistical
evaluation, wrote the manuscript in partial fulfillment of requirements for ylic or phosphoric acid groups. These are hydrolyzed and
post-doctoral “Dr. Habil.” degree. attach to hydroxyapatite via hydrogen bonding, resulting
b Research Associate, Dental Clinic 1, Department of Restorative Dentistry in a complex with low initial pH and high hydrophilicity.10
and Periodontology, Friedrich Alexander University Erlangen-Nürnberg, Er- On the restoration side, chemical bonding is mediated
langen, Germany. Idea, hypothesis, proofread the manuscript, contributed
substantially to discussion, consulted on statistical evaluation. by a silane coupling agent on silica-based ceramics or
c Research Assistant, Dental Clinic 1, Department of Restorative Dentistry
by directly established phosphate links to zirconia sub-
and Periodontology, Friedrich Alexander University Erlangen-Nürnberg, Erlan- strates.8 Once the bonding domains are created, the
gen, Germany. Idea, hypothesis, performed the experiments. reaction takes the route of pH neutralization, based on
d Professor and Department Chair, Dental Clinic 1, Department of Restorative the acid-base reaction between acidic groups of func-
Dentistry and Periodontology, Friedrich Alexander University Erlangen-Nürn-
berg, Erlangen, Germany. Proofread the manuscript, contributed substan-
tionalized monomers and ions of the acid-soluble glass
tially to discussion. fillers, calcium hydroxide,14 or the mineralized tooth tis-
e Associate Professor, Dental Clinic 1, Department of Restorative Dentistry sue.10 Significant differences in pH neutralization behav-
and Periodontology, Friedrich Alexander University Erlangen-Nürnberg, ior have been observed among different self-adhesive
Erlangen, Germany. Idea, hypothesis, experimental design, consulted on cements.20 Improper pH neutralization leads to exces-
statistical evaluation, contributed substantially to discussion, proofread the
manuscript. sive hydrophilicity of the cured cement, subsequent
reduction of mechanical properties,14,20 and increased
Correspondence: Dr. José Zorzin, Dental Clinic 1, Department of Restorative volume expansion15 due to water sorption.
Dentistry and Periodontology, Friedrich Alexander University Erlangen-Nürn-
berg, Glückstr. 11, D-91054 Erlangen, Germany. Tel: +49-9131-853-6479, The setting mechanism of self-adhesive resin cements
Fax: +49-9131-853-3603. e-mail: [email protected] follows a typical chemical- and light-curing free-radical po-

Vol 16, No 6, 2014 541

Zorzin et al

Table 1 Materials used (information as disclosed by the manufacturers)

Material Manu- Shade Contents Fillers

facturer, Lot
Batch No.
RelyX 3M ESPE A2 Base paste: mono-, di- and triglycerine dimethacrylate ester of Base: inorganic fillers
Unicem 2 (Seefeld, phosphoric acid 20-30 wt%, 2,2’-ethylene dioxydiethylmethacry- 43 vol%, glass powder
Automix Germany) late 10-20 wt% 45-55 wt%, silanized SiO2
4955054 Catalyst paste: bisphenol A bis3- (methacryloxypropyl) ether 1-10 wt%, grain size (D 90%)
substituted dimethacrylate 20-30 wt%, barbituric acid <5 wt%, 12.5 μm
1,12-dodecandiyl bismethacrylate <5 wt%, sodium toluol-4-sul- Catalyst: glass powder
finate <5 wt%, calcium hydroxide <2 wt%, methacrylated aliphatic 45-55 wt%, TiO2 <0.5 wt%
amine <1 wt%

G-Cem GC Europe A2 Paste A: urethane dimethacrylate (UDMA) 10-25 wt%, n.a.

LinkAce (Leuven, Bel- Y-methacryloxypropyltrimethoxysilane >2.5 wt%
gium) Paste B: urethane dimethacrylate (UDMA) 25-50 wt%,
12102444 Y-methacryloxypropyltrimethoxysilane >2.5-10 wt%,
Α, α-dimethylbenzylhydroperoxide

Maxcem Kerr Hawe Yellow 2-5% hydroxyethylmethacrylate (HEMA), 4-methoxyphenol 69 wt%

Elite (Bioggio, (MEHQ) >1%, cumene hydroperoxide (CHPO) >1%
Switzerland)
4247192

lymerization.10 The degree of cure is an important aspect Specimen Preparation

determining physical and mechanical material proper-
ties,11 wear resistance,9 and biocompatibility.17,19 The Zirconia
low pH resulting from functionalization is suspected to Two hundred forty rectangular bars were cut from yt-
inhibit the free-radical chain reaction, thus affecting the tria-stabilized zirconia blocks (Y-TZP, Vita In-Ceram YZ
degree of conversion and extent of polymerization of self- for inLab, VITA Zahnfabrik; Bad Säckingen, Germany),
adhesive resin cements.1,6,18 A purely chemical polymer- cleaned, and sintered at 1530°C for 2 h with a 600°C/h
ization reaction is slow and may suffer from competition heating rate in an EVA 1700 (Linn High Therm; Eschen-
with the acid-base neutralization process of the functional felden, Germany) to their final dimensions (3 mm high,
groups. By light curing, free radical formation and chain 3 mm wide, 9 mm long). All specimens were air abraded
growth occur in an accelerated pace, maximizing both with 35-μm Al2O3 particles (Hasenfratz; Assling, Germany)
degree of conversion18 and depth of cure.6 at 1.5 bar pressure for 7 s from a 10-mm distance. After
As different self-adhesive systems differ in pH-neutrali- air abrasion, all bars were ultrasonically cleaned (5 min in
zation ability and chemical composition, it is expected that isopropanol) and subsequently dried. Two bars were luted
these factors will affect their curing behavior, with probable perpendicularly (forming a bonded area of 9 mm2) with a
consequences for bonding effectiveness. Therefore, this constant pressure of 10 N, following the manufacturers’
study was conducted on the influence of curing mode on instructions (n = 40 per material). Half of the specimens
bond strength of different commercially available self-ad- were light cured (40 s from each side) using an Elipar Tri-
hesive resin cements to zirconia and lithium disilicate sub- light (3M ESPE) at 750 mW/cm2, while the other half was
strates. Mechanical and bonding stability was assessed left to self-cure under exclusion of light. All specimens
by subjecting the bonded interfaces to thermocycling to were stored for 24 h in distilled water at 37°C. After
simulate the thermochemical challenges posed by the oral storage, half of the specimens (n = 10 per material and
environment. For the self-adhesive cements examined, the curing mode) were immediately submitted to tensile bond
following null hypotheses were tested: (1) curing mode and strength testing, and the other half (n=10 per material
aging have no significant influence on bond strength perfor- and curing mode) underwent TBS testing after thermocy-
mance; (2) cement chemistry is irrelevant to bond strength cling (TC, 5000 cycles, 5°C/55°C, 30-s dwell time).
to lithium disilicate and zirconia substrates.
Lithium disilicate
Two hundred forty rectangular bars (3 mm high, 3 mm
MATERIALS AND METHODS wide, 9 mm long) were cut from lithium disilicate ingots
(IPS e.max Press MO3, Ivoclar Vivadent; Schaan, Liechten-
Three commercially available self-adhesive resin ce- stein). All bars were HF etched for 20 s (IPS Ceramic Etch-
ments were examined in this study: RelyX Unicem 2 Au- ing Gel, Ivoclar Vivadent) and silanized as recommended
tomix (3M ESPE; Seefeld, Germany), G-Cem LinkAce by the manufacturer (ESPE SIL, 3M ESPE). Two bars were
(GC Europe; Leuven, Belgium), and Maxcem Elite (Kerr luted perpendicularly (forming a bonded area of 9 mm2)
Hawe; Bioggio, Switzerland). Table 1 shows their main with a constant pressure of 10 N following manufacturers’
chemical compositions. instructions (n = 40 per material). Half of the specimens

542 The Journal of Adhesive Dentistry

 Zorzin et al

Fig 1 Tensile test setup with low compli-

ance rope (Dyneema SK75) in a pulley
holding the sample.

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

RelyX Self 13.90 (3.52)E 19.42 (4.93)1,C,D,E

Tensile Bond Strength Testing
Unicem 2 Dual 21.52 (3.16)C,D 24.12 (4.39)B,C
Tensile bond strength testing was performed using a
rope-assisted experimental set-up (Fig 1) as described Self 21.45 (4.46)C,D 17.20 (4.27)D,E
by Lohbauer12 and Amaral.4 The test was carried out G-Cem
LinkAce 27.28 (5.41)A,B 30.16 (5.17)A
in a universal testing machine (Z 2.5, Zwick-Roell; Ulm, Dual
Germany) with a crosshead speed of 1 mm/min. A
Maxcem Self 14.54 (3.07)E 3.89 (4.13)1,F
low compliance rope was used (Dyneema SK75, DSM
Dyneema; South Stanley, NC, USA) to hold the sample Elite Dual 19.98 (6.30)C,D 14.21 (5.11)1,E
and a pulley to carry the rope. The TBS values were cal-
Number of pre-test failures is shown by superscript numerals, homoge-
culated by dividing the maximum applied load (N) by the neous subsets are indicated by same superscript letters (S-N-K, α = 0.05).
area of the adhesive interface, measured with a digital
caliper after testing.

Statistical Analysis Tensile Bond Strength to Zirconia

For each bonding substrate (zirconia or lithium dis- With the exception of RelyX Unicem 2 after thermocy-
ilicate), data were analyzed by one-way ANOVA, and ho- cling, dual-curing resulted in significantly (p < 0.05)
mogenous subsets were determined using the post-hoc increased tensile bond strengths when compared to
Student-Newman-Keuls test. All tests were performed at self-curing, both after 24 h and thermocycling. G-Cem
a significance level of α = 0.05 using statistical software LinkAce presented the significantly (p < 0.05) highest
(SPSS Version 21.0, IBM; Armonk, NY, USA). bond strengths in both curing modes (27.28 MPa dual
curing, 21.45  MPa self-curing) after 24 h, followed by
RelyX Unicem 2 and Maxcem Elite. After thermocycling,
RESULTS the dual-cured G-Cem LinkAce specimens presented the
significantly highest (p < 0.05) bond strength values
The mean (± standard deviation) values for tensile bond (30.16 MPa). In the self-curing mode after thermocy-
strength and the number of pre-test failures are summa- cling, RelyX Unicem 2 and G-Cem LinkAce did not show
rized in Table 2 and Fig 2 for the zirconia groups and in significantly different (p = 0.165) mean bond strengths,
Table 3 and Fig 3 for the lithium disilicate groups. but had significantly better (p < 0.05) mean TBS than

Vol 16, No 6, 2014 543

Zorzin et al

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

Material Curing Tensile bond strength [MPa] DISCUSSION

mode
24 h Thermocycling For TBS testing, the experimental set-up described by
Self 17.00 (4.50)A,B 17.47 (3.77)A,B
Lohbauer12 and Amaral4 was chosen as it eliminates
RelyX shear stress and provides a purely tensile stress along
Unicem 2 23.80 (7.53)A 18.63 (9.94)A,B
Dual the interface plane. The low compliance rope (Dyneema
SK75, DSM Dyneema) and the pulley to carry the rope
G-Cem Self 20.56 (5.67)A,B 17.52 (3.64)1,A,B
ensured balanced force distributions at the two loading
LinkAce Dual 23.56 (3.33)A 20.74 (6.22)1,A,B points.
In contrast to e.max CAD, e.max PRESS ingots are
Maxcem Self 21.69 (6.22)A,B 14.18 (7.25)B
already in the final crystallized state. The e.max PRESS
Elite Dual 18.75 (6.20)1,A,B 20.64 (5.01)A,B ingots are just made molten again for injection. No
changes in crystal structure can be found between the
Number of pre-test failures is shown by superscript numerals, homo-
geneous subsets are indicated by same superscript letters (S-N-K, e.max PRESS ingots (before pressing) and the final restor-
α = 0.05). ation (after pressing). This can be seen macroscopically
when HF-etching the ingot. It will show the same opaque
surface as the etched pressed restoration. In SEM im-
corresponding Maxcem Elite group (3.89 MPa). In both ages, the same crystals structure can be seen before
curing modes, thermocycling significantly (p < 0.05) and after pressing. Thus, the ceramic structure used in
reduced the tensile bond strength of Maxcem Elite to the experiment in this study is the same as that used in
zirconia, from 14.54 MPa to 3.89 MPa in the self-curing the oral cavity.
and from 19.98 MPa to 14.21 MPa in the dual-curing The pretreatment protocol used for zirconia in this
mode. study involved sandblasting without priming, which
leads to tensile bond strengths comparable to those
Tensile Bond Strength to Lithium Disilicate attained for lithium disilicate after HF etching and si-
Dual curing resulted in a nonsignificant (p > 0.05) in- lanization. Many reports have shown that bond strength
crease in tensile bond strength compared to the self- to zirconia is improved by airborne particle abrasion,
curing mode for RelyX Unicem 2 and G-Cem LinkAce. which increases the surface area through roughen-
Further, no statistically significant (p > 0.05) differences ing.4,5 Besides micromechanical retention, chemical
in the bond strength to lithium disilicate were detected. bonding between phosphate monomers and zirconia
This was found within each material cement group (ir- also takes place.8

544 The Journal of Adhesive Dentistry

 Zorzin et al

40

35 24 h

Thermocycling

Tensile bond-strength [MPa]

30

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

Vol 16, No 6, 2014 545

Zorzin et al

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.

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546 The Journal of Adhesive Dentistry

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