What are the approaches to bonding resin to zirconia?

This summary is based on the Critical Appraisal published in the Journal of Esthetic and Restorative Dentistry: Resin bonding to zirconia (December 2012)

Context

The use of zirconia for dental applications has increased substantially over the past decade. This is evident from the wide variety of commercial products available on today’s market and the wealth of information in the scientific literature. Its uses range from single-unit crowns and fixed-partial dentures to entire dental implant systems and nanoparticle fillers in composite resins. Zirconia, sometimes described as “ceramic steel,” possesses the ideal properties for dental use: superior strength, toughness, and fatigue resistance, excellent wear properties, and biocompatibility.

However, the nonreactive surface of zirconia presents a consistent issue of poor adhesion to other materials (synthetic or tissue). In this appraisal, the authors look at several research manuscripts that describe approaches and pretreatments to increase zirconia surface reactivity for enhanced adhesion with resin cements.

Studies Reviewed

Effect of surface treatments on the resin bond to zirconium-based ceramic. Int J Prosthodont. 2005 Jan-Feb;18(1):60-5.

Hydroxylation of dental zirconia surfaces: characterization and bonding potential. J Biomed Mater Res B Appl Biomater. 2008 Nov;87(2):461-7. 

Bonding of primed zirconia ceramics: evidence of chemical bonding and improved bond strengths. Am J Dent. 2012 Apr;25(2):103-8.

Key Messages

• Research has focused on adhesion and bond strengths to zirconia, but the question is “what is the gold standard—what is the bond strength we are trying to achieve?”
• Clinical data are needed to further understand adhesion issues—and studies are just now being published. Preliminary clinical research indicates that some failures are due to loss of adhesion but more are due to chipping of veneer porcelain.
• Commercial adhesion products are continuously being developed and optimized for clinical use.
• It is anticipated that the use of zirconia in dentistry will increase in the future, so reliable clinical adhesion solutions are needed.
• Based on the literature and the commercial products available to clinicians today, using novel primers (e.g., Z-Prime Plus) coupled with low pressure air-abrasion would be more than sufficient for adequate bonding of resin cement.

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