Adhesion of Different Resin Cements to Zirconia: Effect of Incremental versus Bulk Build Up, Use of Mould and Ageing

Abstract

Bonding to zirconia presents a great challenge, as the clinical guidelines for predictable adhesion are not sufficiently validated. The aim of this study was to assess the influence of various bonding methodologies of various resin cements on zirconia, using different aging protocols. Manufactured zirconia specimens (N = 300 and n = 20 per group) were randomly assigned to three luting protocols: 1—in mould incremental build up; 2—in mould incremental build up with mould removal; 3—in mould non-incremental bulk build up. Five dual, photo- and chemical-cure resin cements were used, namely, Variolink Esthetic (Ivoclar), Tetric (Ivoclar), Panavia (Kuraray), TheraCem (Bisco), and RelyX UniCem (3M ESPE), and were applied on primed zirconia using photopolymerization protocols. Thereafter, the specimens were subjected to the following three ageing methods: 1—dry; 2—thermocycling (×5000; 5−55 °C); 3—3−6 months of water storage. Using a universal testing machine, the specimens were loaded under shear, at 1 mm/min crosshead speed. An analysis of the data was performed using three-way ANOVA and the Bonferroni method. The moulding type, ageing and luting cement significantly affected the results (p < 0.05). Among all the protocols under dry conditions, TheraCem (16 ± 3; 11 ± 1; 16 ± 3) showed the best bond strength, while, after thermocycling, TheraCem (7 ± 2) and Tetric (7 ± 2) performed the best with Protocol 1. In Protocol 2, RelyX (7 ± 3) presented the highest result, followed by TheraCem (5 ± 3) and Tetric (5 ± 1) (p < 0.05). Using Protocol 3, RelyX (10 ± 6) showed the highest result, followed by TheraCem (7 ± 2) and Panavia21 (7 ± 2) (p < 0.05). Six months after water storage, TheraCem presented the highest result (10 ± 2) in Protocol 1, while, in Protocols 2 and 3, Tetric (10 ± 2; 15 ± 5) presented the highest result, followed by TheraCem (6 ± 2; 8 ± 3). Adhesion tests using the incremental or bulk method, using moulds, showed the highest results, but removing the mould, and the subsequent ageing, caused a decrease in the adhesion of the resin cements tested on zirconia, probably due to water absorption, with the exclusion of Tetric.

Keywords: adhesion; adhesive cementation; ageing; bond strength; macroshear; test method; zirconium dioxide.

Figure 2

Illustration of the three application modes: mould filled incrementally, mould removed after incremental build up, and mould filled in bulk. z: Zirconia surface.

Figure 1

Flowchart outlining experimental arrangement and alignment of groups.

Figure 3

Mean and standard deviation values (MPa) for the 5 cements (Variolink, Tetric, Panavia 21, TheraCem and RelyX Unicem) for the 3 protocols and ageing methods (dry, thermocycling and 6 months of water storage).

Figure 4

(a–i) In mould incremental build up (Protocol 1): (a) Δdry—thermocycling, (b) Δdry—6 months of water storage, (c) Δthermocycling—6 months of water storage. (d–f) In mould incremental build up with subsequent mould removal (Protocol 2): (d) Δdry—thermocycling, (e) Δdry—6 months of water storage, (f) Δthermocycling—6 months of water storage. (g–i) In mould non-incremental bulk build up: (g) Δdry—thermocycling, (h) Δdry—6 months of water storage, (i) Δthermocycling—6 months of water storage.