Comparative shear-bond strength of dental self- adhesive resin cement to Zirconia: a Systematic Review

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Ohshin Kwon

5th year, 12 gr

Comparative shear-bond

strength of dental self-

adhesive resin cement to

Zirconia: a Systematic Review

Master’s Thesis

Supervisor

Doctor, Rimantas Ožiūnas

1 Kaunas,2019

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LITHUANIAN UNIVERSITY OF HEALTH SCIENCES MEDICAL ACADEMY

FACULTY OF ODONTOLOGY ORTHOPEDIC CLINIC

Comparative shear-bond strength of dental self-adhesive resin cement to Zirconia: a Systematic

Review

Master’s Thesis

The thesis was done

by student ... Supervisor ...

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2 Kaunas,2019

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EVALUATION TABLE OF THE MASTER’S THESIS OF THE

TYPE OF SYSTEMIC REVIEW OF SCIENTIFIC LITERATURE

Evaluation:... Reviewer:...

(scientific degree. Name and surname)

Reviewing date: ...

No. MT parts MT evaluation aspects

Compliance with MT requirements and evaluation Yes Partially No 1 Summary (0.5 point)

Is summary informative and in compliance with the

thesis content and requirements? 0.3 0.1 0

2 Are keywords in compliance with the thesis essence? 0.2 0.1 0 3

Introduction, aim and tasks

(1 point)

Are the novelty, relevance and significance of the

work justified in the introduction of the thesis? 0.4 0.2 0 4 Are the problem, hypothesis, aim and tasks formed

clearly and properly? 0.4 0.2 0

5 Are the aim and tasks interrelated? 0.2 0.1 0

6 Selection criteria of the studies, search methods and strategy (3.4 points)

Is the protocol of systemic review present? 0.6 0.3 0 7

Were the eligibility criteria of articles for the selected protocol determined (e.g., year, language, publication condition, etc.)

0.4 0.2 0

8

Are all the information sources (databases with dates of coverage, contact with study authors to identify additional studies) described and is the last search day indicated?

0.2 0.1 0

9

Is the electronic search strategy described in such a way that it could be repeated (year of search, the last search day; keywords and their combinations; number of found and selected articles according to the combinations of keywords)?

0.4 0.1 0

10

Is the selection process of studies (screening, eligibility, included in systemic review or, if applicable, included in the meta-analysis) described?

0.4 0.2 0

11

Is the data extraction method from the articles (types of investigations, participants, interventions, analysed factors, indexes) described?

0.4 0.2 0

12

Are all the variables (for which data were sought and any assumptions and simplifications made) listed and defined?

0.4 0.2 0

13

Are the methods, which were used to evaluate the risk of bias of individual studies and how this information is to be used in data synthesis, described?

0.2 0.1 0

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14 Were the principal summary measures (risk ratio,

difference in means) stated? 0.4 0.2 0

15

Systemization and analysis of

data (2.2 points)

Is the number of studies screened: included upon assessment for eligibility and excluded upon giving the reasons in each stage of exclusion presented?

0.6 0.3 0

16

Are the characteristics of studies presented in the included articles, according to which the data were extracted (e.g., study size, follow-up period, type of respondents) presented?

0.6 0.3 0

17

Are the evaluations of beneficial or harmful outcomes for each study presented? (a) simple summary data for each intervention group; b) effect estimates and confidence intervals)

0.4 0.2 0

18 Are the extracted and systemized data from studies

presented in the tables according to individual tasks? 0.6 0.3 0 19 _Discussion

(1.4 points)

Are the main findings summarized and is their

relevance indicated? 0.4 0.2 0

20 Are the limitations of the performed systemic review

discussed? 0.4 0.2 0

21 Does author present the interpretation of the results? 0.4 0.2 0 22

Conclusions (0.5 points)

Do the conclusions reflect the topic, aim and tasks of

the Master’s thesis? 0.2 0.1 0

23 Are the conclusions based on the analysed material? 0.2 0.1 0

24 Are the conclusions clear and laconic? 0.1 0.1 0

25

References (1 point)

Is the references list formed according to the

requirements? 0.4 0.2 0

26 Are the links of the references to the text correct? Are

the literature sources cited correctly and precisely? 0.2 0.1 0 27 Is the scientific level of references suitable for

Master’s thesis? 0.2 0.1 0

28

Do the cited sources not older than 10 years old form at least 70% of sources, and the not older than 5 years – at least 40%?

0.2 0.1 0

Additional sections, which may increase the collected number of points

29 Annexes Do the presented annexes help to understand the

analysed topic? +0.2 +0.1 0

30

Practical Recommen-

dations

Are the practical recommendations suggested and are

they related to the received results? +0.4 +0.2 0 31

Were additional methods of data analysis and their results used and described (sensitivity analyses, meta- regression)?

+1 +0.5 0

32

Was meta-analysis applied? Are the selected statistical methods indicated? Are the results of each meta- analysis presented?

+2 +1 0

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General requirements, non-compliance with which reduce the number of points

33

General require- ments

Is the thesis volume sufficient (excluding annexes)?

15-20 pages (-2 points) <15 pages (-5 points) 34 Is the thesis volume increased artificially? -2

points -1 point 35 Does the thesis structure satisfy the requirements of

Master’s thesis? -1 point -2 points

36 Is the thesis written in correct language,

scientifically, logically and laconically? -0.5 point -1 points 37 Are there any grammatical, style or computer

literacy-related mistakes?

-2

points -1 points 38 Is text consistent, integral, and are the volumes of its

structural parts balanced? -0.2 point -0.5 points

39 Amount of plagiarism in the thesis. >20% (not evaluated) 40

Is the content (names of sections and sub- sections and enumeration of pages) in compliance with the thesis structure and aims?

-0.2 point -0.5 points

41

Are the names of the thesis parts in compliance with the text? Are the titles of sections and sub-sections distinguished logically and correctly?

-0.2 point -0.5 points 42 Are there explanations of the key terms and

abbreviations (if needed)? -0.2 point -0.5 points

43 Is the quality of the thesis typography (quality of

printing, visual aids, binding) good? -0.2 point -0.5 points

*In total (maximum 10 points):

*Remark: the amount of collected points may exceed 10 points. Reviewer’s comments:

Reviewer’s name and surname Reviewer’s signature

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Summary

Aim: To analyze the shear bond strength of dental self-adhesive resin cement to zirconia with various

factors.

Material and methods: A systematic review was carried out to identify relevant studies reporting data

about shear bond strength of dental self-adhesive resin cement to zirconia. This systematic review was done according to PRISMA-P criteria. The data was extracted from the selected 7 research articles. The search was performed through electronic databases such as ScienceDirect, PubMed and Wiley Online and was restricted to publications from 2010- 2019.

Results: Based on all 7 analyzed articles, after thermocycling the shear bond strength of dental

self-adhesive resin cement to zirconia decreased except Clearfil SA Luting cement. When using a ceramic primer or sandblasting on zirconia substrate, the shear bond strength increased compared to without any primer or pretreatment. In the setting mode of the cement, Polymerization with light-cure showed higher values compare to self-polymerization.

Conclusion: Based on analyzed literature, it can be concluded

1. Aging condition significantly affects the shear bond strength of dental self-adhesive resin cement to

zirconia

2. Use of a ceramic primer had a positive impact on the bond-strength properties of zirconia

3. The performance of the cements was greatly dependent on the type of setting reaction, with light-polymerized mode displaying significantly higher bond strengths than the self-light-polymerized mode. 4. Bond strengths of self-adhesive resin cement to zirconia increased by sandblasting.

Keywords: Shear bond strength, Self-adhesive resin cement, Zirconia, Thermocycling

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Introduction

Adequate adhesion between restorations and teeth is one of the major factors of successful indirect restoration. For adequate adhesion, cement suitable for the restoration type must be selected. An ideal luting cement must provide sustainable bonds with different materials, adequate compression and tensile strengths, wettability and resistance to dissolution in the oral cavity [1]. The dentist of today has the choice of a water-based luting agent (zinc phosphate, zinc polycarboxylate, glass ionomer or zinc oxide-eugenol) or a resin system with or without adhesive [2].

Zirconia ceramics have increased in prosthetic dentistry based on CAD / CAM technology, which improves process and accuracy. Since zirconia has high strength, a typical ZPC or RMGIC can be used to cement it. However, when resin cement were used, the resistance to restoration can be increased, marginal sealing can be improved and restoration fracture strength can be increased [1,3]. In conventional resin cement, a pretreatment procedure is required to achieve adhesion, and the procedure is complicated. [7] To simplify the treatment process, a self-etching system was developed to prevent collapse of collagen fiber from in the dentin through acid etching. However, the permeation of moisture through the adhesives can cause the bond strength to deteriorate when hardening is delayed. [8] To overcome this problem, self-adhesive resin cement (SARC) that combines the adhesives and cements were developed. These cements offer the mechanical, aesthetic, and adhesive advantages of typical resin cements. Self-adhesive cement does not require any pretreatment of the tooth surface. [4]

The shear bond strength between luting cement and substrate can demonstrate resistance to fracture and durability of their bonding. Many of studies carried out about self-adhesive resin cement bonding to zirconia with surface treatments, artificial aging conditions, ceramic primers, mode of polymerization and so on. The aim of this literature review is to analyze the shear bond strengths of self-adhesive resin cement to zirconia with various factors.

Aim: To analyze the shear bond strength of dental self-adhesive resin cement to zirconia with various

factors

Task :

1. To evaluate the shear bond strength of self-adhesive resin cement to zirconia after thermocycling. 2. To evaluate the shear bond strength of self-adhesive resin cement to zirconia with primer.

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3. To evaluate the shear bond strength of self-adhesive resin cement to zirconia in different setting type. 4. To evaluate the shear bond strength of self-adhesive resin cement to zirconia with sandblasting.

SELECTION CRITERIA OF STUDIES. SEARCH METHODS AND STRATEGY

1.1 Selection criteria of studies

This systematic review was done according to PRISMA-P (Preferred Reporting Items for Systematic review and Meta-Analysis Protocols) criteria, to analyze comparative shear-bond strength of dental self-adhesive resin cement to zirconia. Moreover, inclusion and exclusion criteria and filters covered the following statements.

Inclusion criteria including for selection were the following:

1) scientific articles of randomized clinical trials and (prospective and retrospective) observational clinical studies

2) articles are not older than 10 years, 3) published in English,

4) In vitro

Furthermore articles and studies were selected that involved following exclusion criteria such as: 1) studies on animals,

2) author debates, 3) abstracts, 4) summaries

1.2 Search methods

The systematic review was done by one investigator during the period 2018 - April 2019. The electronic search included web databases naming: ScienceDirect, PubMed, Wiley Online. The search was performed by combining keywords as self-adhesive resin cement, shear bond strength, zirconia. All those electronic databases were accessed through the online library of the Lithuanian University of Health science´s EZproxy.

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1.3 Study selection

Combinations of keywords used for the search strategy in electronic databases were chosen according to the above-mentioned topic. During the search identification phase, each database was accessed. Following 2 keywords combinations were used in each database: 1) Shear bond strength 2) self-adhesive resin cement 2) zirconia

After completing the first search, with only two general keywords, the extent of found articles was too immense, to elaborate an accurate search. Further searches were initiated by using the third keyword, to overcome this problem.

Table 1. Pubmed

In pubmed, with keyword, ‘shear-bond strength of dental self-adhesive resin cements to zirconia". The results were 39 for the total. And with using filters publication dates in 10 years, 38 results and in 5 years were 18 results.

Table 2. ScienceDirect

keyword filter results

shear-bond strength of dental self-adhesive resin cement to

zirconia

research articles 160

zirconia

research articles, 10 years 118

zirconia

No 39

zirconia

10 years 38

zirconia

5 years 18

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zirconia

research articles, 5 years 62

In ScienceDirect with keyword, ‘shear-bond strength of dental self-adhesive resin cements to zirconia". The results were 160 for the total. And with using filters publication dates in 10 years, 118 results and in 5 years were 62 results.

Table 3. Wiley Online Library

zirconia

10 years 125

zirconia

5 years 68

In Wiley Online Library with keyword, ‘shear-bond strength of dental self-adhesive resin cements to zirconia". The results showed with using filters publication dates in 10 years, 125 results and in 5 years were 68 results.

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Figure 1

Identification

Screening

Eligibility

Included

Records identified through databases with a combination of three keywords "shear-bond strength of dental self-adhesive resin cement to zirconia."

ScienceDirect: 118 PubMed: 38 WileyOnline: 125

( n = 281 )

Additional article from other sources

( n = 2)

Records after using keywords with filter, 10 years

( n = 283)

Abstracts screened ( n = 41)

not relevance titles were excluded

( n = 242)

Full-text articles assessed for eligibility

( n = 28)

duplicates removed ( n = 13)

Studied included in qualitative synthesis

( n = 7)

Due to lack of relevant data

( n = 21 )

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1.4 Data extraction

Data was extracted via all the databases that were selected. A number of substrate, Name of self-adhesive resin cement, Mean shear bond strength, with/without thermocycling, setting mode, setting time, with/without sandblasting, with/without primer.

1.5 Study variables

In the tables, the main purpose was to examine variables of shear bond strength of self-adhesive resin cement to zirconia by each various methods which were divided in to with/without primer, with/without sandblasting, Polymerization mode and time.

1.6 Risk of bias in studies

Unfortunately, among other limitations, most of the data carried out in vitro, with special testing machine and substrates, which in its turn could or not cause a higher risk of bias that should be taken in consideration while reading this systematic review. In other words, the selected studies can give an overestimation, which might not be closer to clinical truth.

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2. Systemization and analysis of data (Table 4)

Christine Keul Et al. 2013[8]

Cement n Thermocycling Sandblasting primer Setting

mode Setting time Mean(SD) RelyX Unicem 110 - - - LP - 7.5 (1.3) + - - LP - 2.7 (2.9) RelyX Unicem 110 - - + LP - 11.4 (1.3) + - + LP - 8.2 (1.6) G-CEM 110 - - - LP - 6.2 (1.7) + - - LP - 4.2 (4.5) G-CEM 110 - - + LP - 7.1 (1.3) + - + LP - 6.4 (3.1) Altay Uludamar Et al.2012 [9] Multilink® Automix 10 - - + SP 10min 2,47±0,31 Multilink® Automix 10 - + + SP 10min 5,42±1,28 Multilink® Sprint 10 - - - SP 10min 1,84±0,27 Multilink® Sprint 10 - + - SP 10min 4.35±0.72

Si-Eun Lee. Et al. 2015[1] G-CEM LinkAce 10 - - - LP 5s 3.96 G-CEM LinkAce 10 + - - LP 5s 2.66 14

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Maxcem Elite 10 - - - LP 5s 2.86 Maxcem Elite 10 + - - LP 5s 2.08 Clearfill SA Luting 10 - - - LP 5s 3.90 Clearfill SA Luting 10 + - - LP 5s 4.62 PermaCem 2.0 10 - - - LP 5s 4.19 PermaCem 2.0 10 + - - LP 5s 2.99 RelyX U200 10 - - - LP 5s 2.84 RelyX U200 10 + - - LP 5s 2.36 SmartCem 2 10 - - - LP 5s 3.93 SmartCem 2 10 + - - LP 5s 3.44 Seto KB. Et al.2013[15] MaxCem - - + - - - 28(3) MaxCem - + + - - - 0.1(0.1) RelyX Unicem - - + - - - 24(4) RelyX Unicem - + + - - - 9(5) GCem - - + - - - 36(9) 15

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GCem - + + - - - 16(7) Markus B. Et al. 2010[10] BisCem 10 + - - LP + 0.3 RelyX Unicem Clicker 10 + - - LP + 1.4 RelyX Unicem Applicap 10 + - - LP + 7.9 Maxcem 10 + - - LP + 0.6 G-Cem 10 + - - LP + 8.0 Clearfil SA Cement 10 + - - LP + 7.6 BisCem 10 + + - LP + 2.8 RelyX Unicem Clicker 10 + + - LP + 3.0 RelyX Unicem Applicap 10 + + - LP + 22.4 Maxcem 10 + + - LP + 8.2 G-Cem 10 + + - LP + 14.6 Clearfil SA Cement 10 + + - LP + 18.4 Shin YJ Et al. 2014[19] Clearfil SA Luting cement 10 + - - LP 20s 4.57 ± 1.34 Clearfil SA Luting 10 + + - LP 20s 9.67 ± 1.06 16

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cement Clearfil SA Luting cement 10 + - + LP 20s 6.51 ± 0.66 Clearfil SA Luting cement 10 + + + LP 20s 13.17 ± 4.04 Camila Sabatini. Et al. 2013[13] RelyX Unicem 12 - + - SP 15 min 1.4 (0.1) RelyX Unicem 12 - + - LP 15 min 11.0 (0.6) RelyX Unicem 12 - + - SP 24h 16.2 (1.2) RelyX Unicem 12 - + - LP 24h 16.6 (0.4) Maxcem Elite 12 - + - SP 15 min 3.3 (0.3) Maxcem Elite 12 - + - LP 15 min 10.9 (0.5) Maxcem Elite 12 - + - SP 24h 11.9 (1.1) Maxcem Elite 12 - + - LP 24h 16.5 (0.7) 17

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Study characteristic

Christine Keul et al. The authors compared shear bond strength of self-adhesive resin cement to zirconia with/without ceramic primer (RelyX Unicem, G-CEM). They tested shear bond strength before and after thermocycling and with/without ceramic primer. The shear bond strength decreased after thermocycling (0 ~ 35,000cycles). The conclusion of the article implies that ceramic primer in combination with self-adhesive resin composite cement demonstrated a positive effect on SBS to zirconia and should be used for cementation.

Altay Uludamar.et al. [9] the purpose of this study was evaluating the influence of surface preparation on the bond strength of self-adhesive resin cements (Multilink Automix, Multilink Sprint) to zirconium oxide ceramic restorations. With and without sandblasting zirconia blocks were prepared and cemented and testing their shear bond strength by special testing machine. Both types of cement showed the highest bond strength values when specimens were treated with sandblasting. The bond strength of the Multilink Automix cement to the sandblasted zirconia resulted in the highest bond strength values.

Si-Eun Lee. Et al. [1] this study compared shear bond strength of six self-adhesive resin to zirconia before and after 5000 thermocycling. Before thermocycling, the shear bond strength in PermaCem 2.0 showed greater shear bond strength than other cement. After thermocycling, the Clearfill SA Luting showed the highest shear bond strength compared to other cements. Most of the self-adhesive resin cement shows decreased shear bond strength after thermocycling except Clearfill SA Luting cement. B. Markus. Et al this study compared with and without air-particle abrasion the shear bond strengths of six self-adhesive resin cement to zirconium oxide ceramics. Without abrasion, binding strengths were significantly higher than other cement, as revealed by G-Cem (8.0 MPa), RelyX Unicem (7.9 MPa) and Clearfil SA Cement (7.6 MPa). An increase in bonds strength for all test cement is due to the air-particle abrasion. The highest bond strengths for the SB group were found in G-Cem (22.4 MPa) and in Clearfil SA Cement (18.4 MPa). Air-particle abrasion has increased the bond strength of self-adhesive resin cement in zirconia. Adhesive monomer cements (MDP/4-META) were higher than other compositions.

Shin YJ et al. [19] this study aimed to assess the impact of various surface treatments on the shear bond

strength of Y‐TZP (Yttria‐Tetragonal Zirconia Polycrystal) ceramic and resin cements both containing dihydrogen-phosphatic 10‐methacryloyloxidecyl (MDP). Clearfil SA Luting was polymerized on the zirconia surface. Shear bond strength was tested with a universal testing machine Zirconia primer applied after airborne abrasion showed significantly increased shear bond strength resulting in the highest value. In contrast, the control group (No primer and surface treatment) showed the weakest value for shear bond strength.

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Camila Sabatini. Et al. [13] In this study assessed the shear bond strength of self-adhesive resin cements bonded to zirconia tested at different times (15 minutes and 24 hours) and undergoing various setting reactions (Self-polymerization and Light-polymerization). The result of the study shows that significantly higher mean shear bond strength when Light-polymerization mode relative to Self-polymerization mode and for 24 hours relative to 15minutes.

Seto KB. et al. [15] This study investigates the effects of artificial aging by thermocycling to resin cement bonds to zirconia. Three self-adhesive resin cements showed decreased shear bond strength after thermocycles. The number of fatiguing thermocycles very strongly affected bond strength to zirconia.

Discussion

Influence of thermocycling

The conditions most common for testing the durability of resin bonds are long-range storing water and thermal cycling. Thermocycling in an aqueous environment commonly used in the moist oral environment to simulate mechanical fatigue. Thermo-cycling temperature changes use mechanical stress on the interfaces of differential expansion and contraction between dissimilar materials [15]. The main component of SARCs is phosphate-functional monomer. Phosphoric acid phosphate monomers are MHP (6-methacryloxyhexyl phosphate), GPDM (glycerol phosphate dimethacrylate), BisHEMA(2-methacryloxyethyl dihydrogen phosphate) and MDP(10-methacryloxydecyldihydrogen phosphate)[10] .When phosphate monomer is applied to zirconia, the hydrogen group of phosphate monomer and the oxygen group of zirconia slowly react to produce water molecules and to form a stable Zr-O-P covalent bond [1]. There must be sufficient wettability in the early stage of the reaction to use the hydrophilic property, but excessive hydrophilicity can cause swelling that can adversely affect dimensional stability and mechanical strength, thus increasing hydrophobicity need after the initial reaction. [10]. In Christine Keul et al. [8], Seto KB. et al. [15] and Si-Eun Lee. Et al. [1], the authors tested the shear bond strength of self-adhesive resin cement to zirconia before and after thermocycling. From Christine Keul et al. [8], Seto KB. Et al. [15], two studies show decreasing shear bond strength of self-adhesive resin cement to zirconia after thermocycling compared to without. It demonstrates that thermocycling significantly affects the bond strength of cement. Like previous studies, Si-Eun Lee. Et al. [1]. Most of the cement after thermocycling, the shear bond strength was decreased compared to without thermocycling only except Clearfil SA Luting cement. The main reason that Clearfil SA Luting has highest shear bond strength after thermocycling is Clearfil SA Luting cement contains MDP which is a monomer of

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phosphate with a chain of-(CH2)n longer than other monomers of phosphoric acid. Because this longer backbone could increase the cement's hydrophobicity, its bond strength was considered greater than that of other self-adhesive cement with different phosphate monomers [1] From Tanış MÇ et al.[21] as well, the result of the study shows using an MDP monomer containing resin cement increases the bond strength of sandblasted zirconia.

Influence of surface treatment

Several surface treatment methods and techniques have been reported to enhance the bond strength of luting cement to ceramic surfaces. Mechanical surface treatments are used to produce roughness on the ceramic's surface, which increases its surface energy and wettability and exposes more of its surface area to the resin cement, thereby increasing mechanical interlocking and bond strength. For example, sandblasting uses air that contains aluminum oxide (Al2O3) particles with different sizes at a specific pressure to treat the ceramic's surface [16]. Markus B. et al. [10] tested six types of self-adhesive resin cement to zirconium oxide ceramic with and without air-particle abrasion. This study shows that shear

bond strengths of self-adhesive resin cement to zirconia were increased by air-particle

abrasion.Furthermore, cement containing adhesive monomers (MDP/4-META) showed higher values

compared to other compositions. Altay Uludamar.et al. [9] compared shear bond strength of two

self-adhesive resin cements to zirconia with different surface treatment (Sandblasting, finishing diamond bur, YAG laser irradiation). Both cements showed the highest bond strength values when specimens were treated with sandblasting. Kern M et al. [18] as well, the author suggests that to achieve a durable, long-term bonding of ceramic zirconia, when luting resin cements are used without adhesive monomer the combination of air abrasion is necessary. Air abrasion at low pressures with suitable adhesive primers is an effective way to form strong, long-lasting bonds between resin composites and zirconia to minimize possible surface damaging effects from air abrasions at relatively high pressures.

Influence of ceramic primer

Recently, ceramic primers have been introduced to the dental market to increase chemical bonding to zirconia ceramics. These primers that contain a phosphoric acid monomer, 6‑methacryloxyhexylphosphonoacetate (6‑MHPA), 10‑methacryloyloxydecyl dihydrogen phosphate (MDP), ethanol and organophosphate monomer, carboxylic acid monomer and others. Primers that contain phosphoric acid monomers, which bond chemically to metal oxides such as zirconium dioxide and other end of double bond, react to resin cement [16]. Christine Keul et al. [8] and Shin YJ et al. [19]

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these two studies demonstrate using primer had a positive impact on the bond-strengthproperties of self-adhesive resin cement to zirconia.

Influence of setting time and mode

Self‐adhesive resin cements, which can be polymerized in a dual‐curing system, were developed to overcome the disadvantages of conventional resin cements whose application was time-consuming, technological and complicated. Camila Sabatini. Et al. [13] The performance of the cements was greatly dependent on the type of setting reaction, with light-polymerized mode displaying significantly higher bond strengths than the self-polymerized mode. The performance of the cements was also dependent on testing time. After 24 hours, all cement matured showing higher bond strengths than initial values obtained at 15 minutes. This might have been the result of the known ongoing polymerization reaction

after the reaction begins and lasts up to 24 hours. Similar studies on Shim JS et al. [22] and Moraes RR

et al. [20] the result of the study shows the light-cured group had a higher degree of conversion than the

self-polymerized group.

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Conclusion

1. Aging condition significantly affects the shear bond strength of dental self-adhesive resin cement to

zirconia

2. Use of a ceramic primer had a positive impact on the bond-strength properties of zirconia

3. The performance of the cements was greatly dependent on the type of setting reaction, with light-polymerized mode displaying significantly higher bond strengths than the self-light-polymerized mode 4. Bond strengths of self-adhesive resin cement to zirconia were highly variable and increased by air-particle abrasion.

Practical Recommendations

The conclusion suggests achieving durable and long-lasting bonding of ceramic zirconia depends on: 1. Usage of cement containing MDP monomer or applying ceramic primer before cementing zirconia restorations increases shear-bond strength.

2. Polymerization with Light-cure is superior to Self-polymerization when cementing zirconia restorations.

3. Air abrasion of zirconia restoration before cementation increases the bond strength of self-adhesive resin cement.

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10. Blatz MB, Phark JH, Ozer F, Mante FK, Saleh N, Bergler M, Sadan A. In vitro comparative bond strength of contemporary self-adhesive resin cements to zirconium oxide ceramic with and without air-particle abrasion. Clin Oral Investig. 2010 Apr;14(2):187-92

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Comparative shear-bond strength of dental self- adhesive resin cement to Zirconia: a Systematic Review

Ohshin Kwon