The use of MDP-based materials for

bonding to zirconia
Grace de Souza, DDS, MSc, PhD,a Diana Hennig, BSc,b
Anuj Aggarwal, BDS, MPhil,c and Laura E. Tam, DDS, MScd
Faculty of Dentistry, University of Toronto, Toronto, Canada;
Institute of Chemical Technology of Materials Synthesis, Faculty of
Chemistry and Pharmacy, University of Wrzburg, Wrzburg,
Germany
Statement of problem. A strong and stable bond between the luting resin and overlying ceramic restoration is critical to
longevity, but no technique has been established for how to provide such a bond when the core material is zirconia.

Purpose. The purpose of this study was to evaluate the effect of different materials containing 10-methacryloyloxydecyl
dihydrogen phosphate (MDP) on the bond strength to yttria-tetragonal zirconia polycrystal (Y-TZP) ceramic.

Material and methods. Forty Y-TZP slices (Lava) were cemented to substrates (8 groups; n5 in each) with or without the
previous application of an experimental primer (0.5% MDP) or an MDP-based adhesive (Clearl S3 Bond Plus or Scotchbond
Universal) with either an MDP (Clearl SA) or a non-MDP (RelyX Ultimate) luting resin. Specimens were cut, stored in
distilled water, and microtensile tested (5 beams per specimen) at 48 hours and again at 6 months after luting procedures.
The data were analyzed by 4-way ANOVA (a.05) and the Tukey test (a.05). The mode of failure was classied with a
stereomicroscope, and the treated surfaces were analyzed with energy-dispersive x-ray spectroscopy.

Results. Both adhesive (P<.001) and time (P<.001) signicantly affected bond strength. The interaction of any of the factors
was not signicant. The use of an MDP-containing adhesive and the shorter storage time were associated with higher bond
strengths. At 48 hours, an overall incidence of 50.5% of Type 1 mode of failure (adhesive at ceramic/resin interface) occurred,
as opposed to 68% after 6 months of water storage. Energy-dispersive x-ray spectroscopy results showed peaks of carbon and
phosphorus when MDP-based materials were used.

Conclusions. The application of an MDP-based adhesive may improve bond strength to zirconia. However, microtensile bond
strength results for all groups did not remain stable over 6 months. (J Prosthet Dent 2014;-:---)

Clinical Implications
The application of an MDP-based primer and adhesive may improve
early bond strength to zirconia. Dentists should expect the ceramic/resin
bond to degrade with time.

Yttria-tetragonal zirconia polycrystal
(Y-TZP), an yttria-partially stabilized zir-
conia, has been frequently used as a
core material for ceramic crowns and
partial xed dental prostheses.1 However,
achieving a suitable bond between zirco-
nia and tooth structure or core restorative
material is a challenge.2 Because there is
no glass phase or crystalline ller particles
to be selectively etched by an acid
etchant, the conventional hydrouoric
acid application technique does not
improve the bond strength between Y-
TZP and composite resin material.3 Se-
lective acid inltration or the application

Initial results presented at the 91st General Meeting of the International Association for Dental Research, Seattle, Wash, March 2013.
a
Assistant Professor, Department of Clinical Sciences, Faculty of Dentistry, University of Toronto.
b
Graduate student, Institute of Chemical Technology of Materials Synthesis, Faculty of Chemistry and Pharmacy, University of Wrzburg.
c
Student, Faculty of Dentistry, University of Toronto.
d
Professor, Department of Clinical Sciences, Faculty of Dentistry, University of Toronto.

de Souza et al
2 Volume
of a hot etchant did improve initial bond
strength results in one study, but the
longevity of the bonding was not
assessed.4
Airborne-particle abrasion of the in-
taglio Y-TZP surface is another method
of creating a rough ceramic surface that
could facilitate the micromechanical in-
terlocking between zirconia and resin5-7
as well as being an efcient method
of cleaning a contaminated surface.8
The current standard for zirconia-based
restorations is tribochemical treatment,
which consists of airborne-particle
abrasion of the surface with silica-
coated aluminum oxide (Al2O3) parti-
cles. The silica-treated particles roughen
the surface and prepare it to be chemi-
cally activated by a silane coupling
agent.9,10 Airborne-particle abrasion
with alumina particles (125 mm) and
chemical treatment with Metal Primer II
(MEPS, thiophosphoric methacrylate
primer) signicantly improved bond
strength to zirconia,3 whereas the results
with airborne-particle abrasion with 50
mm particles without prior primer treat-
ment have been controversial.11,12
Another study suggested that the size of
the aluminum oxide abrasive particles
had no effect on initial zirconia bond
strength values.13 Nevertheless, several
studies have reported that airborne-
particle abrasion with alumina particles
(50 mm) induces surface damage that
weakens the ceramic by about 25% after
cyclic loading.14,15 Airborne-particle
abrasion is therefore a controversial
mechanical treatment.5
Another approach to improving the
bond strength to zirconia is to develop
a chemical interaction between the
zirconia surface and the applied res-
in monomers. The incorporation of
bisphenol-A diglycidyl methacrylate
(Bis-GMA) to zirconia primers has been
found to have no effect on the con-
tact angle or bond strength between
airborne-abraded zirconia and resin.16
10-methacryloyloxydecyl dihydrogen
phosphate (MDP) monomer has been
used by several investigators for this
purpose,13,17-19 with effective bonding
between the MDP acidic groups (phos-
phoric acid) and the oxide layer of
The Journal of Prosthetic Dentistry
the zirconia.9,17,20 High initial bond
strength values were reported when an
MDP-containing resin (Panavia F 2.0;
Kuraray) was used.13,18,21 However,
bonding decreased after articial aging
of the specimens,2 and it was hypothe-
sized that either the resin was excessively
viscous or the concentration of MDP in
the resin was too low.17 When an MDP-
containing primer (Clearl Ceramic
Primer; Kuraray) was used in conjunc-
tion with an MDP-containing resin
(Clearl Esthetic Cement; Kuraray), high
bond strength values to zirconia were
maintained after thermocycling.19 The
effect of MDP in the resin composition
has been recently investigated in a clin-
ical trial.1 Thirty cantilever anterior res-
torations were cemented with either an
MDP-containing resin or with a phos-
phoric acid methacrylate-containing
adhesive, and no difference was ob-
served between the groups after 60
months.
The MDP patent was owned by the
Kuraray company for 10 years until
2011. Since then, many companies
have incorporated MDP into various
bonding and luting products, such as
primers, adhesives, and resins. It is un-
clear which bonding or luting step most
benets from the addition of MDP, or if
there is a cumulative effect of MDP on
bond strength to zirconia.
Therefore, the purpose of this study
was to evaluate the effect of MDP-
containing materials (primer, adhesive,
and resin-based luting system) on bond
strength to Y-TZP. The null hypotheses
were that MDP-containing bonding
and luting materials have no effect on
bond strength between zirconia and
composite resin substrate and that ag-
ing has no effect on bond strength to
zirconia.
MATERIAL AND METHODS
Four fully sintered Y-TZP blocks
(97% zirconium dioxide stabilized
with 3% yttria) (Lava; 3M ESPE)
(181260 mm) were cut with a low-
concentration diamond blade (Series
15LC; Buehler) at 600 rpm under water
cooling, producing 20 rectangular
- Issue -
(18124 mm) slices.17 An impression
of one of the slices was made, and 6-
mm-thick composite resin substrates
(TPH Spectrum, shade A2, lot number
1201063/expiration date 01-2015;
Dentsply Intl) were produced and aged
in water at room temperature (w25 C)
for at least 30 days to provide hydra-
tion. Both the Y-TZP and the composite
resin slices were roughened on 1 side
with sequential silicon carbide paper up
to 600 grit under water cooling and
hand pressure to standardize the
roughness. The zirconia and composite
resin substrates were cut in half
lengthwise with a diamond blade under
water cooling and at a speed of 600
rpm to obtain 40 specimens of each
material (9124 mm).
The specimens were cleaned in
distilled water in an ultrasonic bath
(Bransonic ultrasonic cleaner; Branson
Ultrasonics) for 10 minutes and stored
in distilled water at room temperature.
The 40 specimens were divided into 8
experimental groups (n5) as shown in
Table I. Groups that did not receive
either primer or adhesive application
were considered as controls. The
sequence of cementation was assigned
by using the random function in Excel
(Microsoft Corp), and composite resin
substrates were prepared for bonding
by following the instructions for the
resin. An experimental MDP-containing
primer solution (0.5% concentration,
lot number 110114/expiration date 11-
2012; Kuraray) was applied to the Y-
TZP surface with a microbrush (groups
PSB, PCB, PUL, and PCL; each is
dened in Table I), and, after 60 sec-
onds, the solvent was removed with a
gentle air stream. For groups PSB and
SBU, the MDP-containing adhesive
(Scotchbond Universal, lot number
476602/expiration date 12-2013; 3M
ESPE) was mixed with the dual poly-
merization activator (Scotchbond Uni-
versal DCA; 3M ESPE) in a mixing well
and applied to the Y-TZP surface with a
microbrush. After 20 seconds, a gentle
air stream was applied. Resin (RelyX
Ultimate; lot number 472829/expira-
tion date 08-2013; 3M ESPE) was
applied to the Y-TZP surface (groups
de Souza et al
- 2014 3
Table I. Experimental groups according to materials (primer, adhesive, and and bond strength (in MPa). A factorial
resin) used to bond to Y-TZP surface ANOVA was performed with the inde-
pendent variables being primer, adhe-
Group MDP Primer MDP-Based Adhesive MDP-Based Resin
sive, resin, and time (a.05).
PSB Yes* Yesy Nox The bonding surfaces of both por-
tions of each tested beam were evalu-
PCB Yes* Yesz Yesk
ated under a stereomicroscope (60
PUL Yes* No Nox
magnication) (Wild M3Z; Wild Leitz
PCL Yes* No Yesk Canada Ltd) to determine the mode of
y
SBU No Yes Nox failure, which was classied as Type 1
CBC No Yesz Yesk (adhesive between ceramic and luting
UL{ No No Nox resin), Type 2 (adhesive between com-
posite resin and luting resin), or Type 3
CL{ No No Yesk
(mixed failure). Selected specimens
*Experimental solution MV 001. were carbon coated, and photomicro-
y
Scotchbond Universal.
z
Clearl S3 Bond Plus. graphs were made with a scanning
x
k
RelyX Ultimate. electron microscope (JSM-66 10 LV;
Clearl SA.
{ JEOL).
Control groups.
The atomic composition of separate
PSB, PUL, SBU, and UL) with a mixing cemented to the zirconia/resin spec- Y-TZP specimens, each treated with the
tip, and the composite resin substrate imen as previously described. MDP-based materials according to the
was placed on the zirconia/resin spec- After 24 hours of storage in deion- manufacturers directions and following
imen and compressed with a 6-N force. ized water at room temperature, the the experimental groups, was examined
Excess resin was removed, and the luted specimens were cut perpendicu- with energy-dispersive x-ray spectros-
specimen was light-polymerized for 20 larly to the interface in 2 perpendicular copy (EDS) to evaluate the availability of
seconds on each side at 650 mW/cm2 axes with a precision saw (IsoMet 1000; chemical components and any cumula-
(DEMI light curing unit; Kerr). Buehler) at 550 rpm under water cool- tive effect of MDP on the surface. Each
The MDP-containing adhesive ing to obtain beams of approximately zirconia specimen was cleaned in
(Clearl S3 Bond Plus, lot number 1.01.0 mm2 in cross-sectional area acetone in an ultrasonic bath (10 mi-
061124/expiration date 06-2015; Kur- and 10 mm in length. The specimens nutes) before the MDP treatment was
aray) was applied to groups PCB and were stored in deionized water at room applied to the surface. The surface to be
CBC. One drop of the adhesive was temperature. Five beams from each evaluated was coated with carbon.
placed in the mixing well, and bonding specimen were picked from the pool of
agent was brushed onto the Y-TZP beams and tested for microtensile bond RESULTS
surface with a microbrush. After 10 strength 48 hours after cutting, and 5
seconds, the surface was dried with a beams per specimen were tested 6 The results of the statistical analysis
mild air stream for 5 seconds and then months later. The water medium was demonstrated that adhesive (P.001)
light-polymerized for 10 seconds. One replaced monthly. Microtensile testing (Table II) and time (P<.001) (Table III)
portion of the resin (Clearl SA, lot was performed (Microtensile Tester had a signicant effect on the micro-
number 056AAA/expiration date 11- Ref. T-61010K; Bisco) at a crosshead tensile bond strength. The use of an
2013; Kuraray) was applied onto the Y- speed of 0.5 mm/min. The dimensions adhesive and the shorter storage time
TZP surface (groups PCB, PCL, of each beam at the bonded interface were associated with higher bond
CBC, and CL) with a mixing tip, and were determined with a digital caliper strengths. Primer (P.149) and resin
the composite resin substrate was to calculate the cross-sectional area (P.59) had no signicant effect on

Table II. Pairwise comparison of adhesive and no-adhesive groups

95% CI for Difference
Adhesive Adhesive Mean Difference Standard Error Signicance Lower Bound Upper Bound

No adhesive Adhesive 2.088 .584 .001 3.254 .921

Adhesive No adhesive 2.088 .584 .001 .921 3.254

Dependent variable: microtensile bond strength.

Adjustment for multiple comparisons: least signicant difference (equivalent to no adjustments). Dependent variable: microtensile bond strength.

de Souza et al
4 Volume - Issue -

Table III. Pairwise comparison of 48-hour groups with 6-month groups

95% CI for Difference
Time Time Mean Difference Standard Error Signicance Lower Bound Upper Bound

48 h 6 mo 2.498* .584 <.001 1.331 3.664

6 mo 48 h 2.498* .584 <.001 3.664 1.331

Dependent variable: microtensile bond strength.

*Mean difference is signicant at .05 level. Adjustment for multiple comparisons: least signicant difference (equivalent to no adjustments).

bond strength. The interaction of any of
the factors was not signicant.
Overall microtensile bond strength
and the Tukey honestly signicant
difference results are presented in
Table IV. The highest 48-hour micro-
tensile bond strength results were as-
sociated with the groups that included
the use of both the MDP-containing
primer and MDP-containing adhesive
(groups PSB and PCB). The more sig-
nicant decreases in microtensile bond
strength results after 6 months occurred
in the group that did not use the MDP-
containing primer and MDP-containing
adhesive (group CL) and in the group
that used both the MDP-containing
primer and the MDP-containing adhe-
sive (group PCB). No pretest failures were
observed in any of the storage periods.
The classication of mode of failure
showed an overall incidence of 50.5%
of Type 1 mode of failure (adhesive at
Y-TZP/luting resin interface) at 48
hours (Figs. 1, 2), as opposed to 68%
after 6 months of water storage. At
least 40% of Type 1 mode of failure (see
Table IV. Microtensile bond strength and Tukey honestly signicant difference
results for experimental groups
Mean (SD)
Group 48 h
PSB 10.6 (1.9)
PCB 10.7 (2.4)
PUL 9.9 (2.5)
PCL 6.7 (1.0)
SBU 9.8 (2.8)
CBC 9.9 (3.5)
UL 7.4 (2.2)
CL 6.4 (4.2)
SD, standard deviation.
The groups are dened in Table I. Bond strength values expressed in MPa; same letters in Tukey
columns indicate statistically similar bond strength results at 5% signicance level.
The Journal of Prosthetic Dentistry
Fig. 1) occurred for all the groups
evaluated, except for group SBU (MDP-
based adhesive) at 48 hours, which
showed 100% Type 3 mode of failure
(mixed failure) (Fig. 3).
The atomic composition evaluated by
EDS showed a higher peak of carbon
when the MDP-based primer was applied
on top of the Y-TZP surface compared
with an untreated specimen (Figs. 4, 5, 6,
and 7). Scotchbond Universal and
Clearl S3 Plus presented similar peaks of
phosphorus. However, Scotchbond
Universal presented a higher silica con-
tent and Clearl S3 a higher carbon
content. When primer, adhesive, and
resin were combined and evaluated, the
combination Scotchbond UniversalRelyX
Ultimate resulted in higher peaks of
carbon and phosphorus.
DISCUSSION
This study evaluated the effect of
different MDP-containing material
(primer, adhesive, and resin) on initial
and long-term bond strength between
Mean (SD)
Tukey 6 mo Tukey
AB 8.5 (2.3)
A 5.6 (3.6)
B 6.1 (2.1)
B 6.6 (2.2)
B 8.0 (2.1)
B 6.7 (2.6)
B 5.6 (2.5) BC
B 4.3 (2.0)
Y-TZP and composite resin substrate.
To standardize the surface roughness,
both Y-TZP and composite resin sur-
faces were sequentially roughened up to
600 grit silicon carbide paper. Although
air-particle abrasion of the intaglio zir-
conia coping is considered a standard
procedure by some authors,1,6,12 this
treatment was not considered, because
the main focus of the study was to
evaluate the chemical bonding between
the adherent surfaces and to evaluate
adhesive procedures.
The bond strength was evaluated
with the microtensile testing technique.
Although the microtensile test is more
labor-intensive than tensile and shear
testing,13 this technique is cost-
effective, because a larger number of
specimens can be produced with a
reduced volume of material. It also
provides a precise observation of the
bonding between luting materials and
clinically relevant substrates by allowing
the selection of specimens free of bub-
bles and other defects and is therefore
more accurate than shear and tensile
tests.22,23 In this study, 5 specimens
were produced per experimental group,
and 5 beams were tested per specimen.
As previously mentioned, no pretest
failures were observed. The bond
strength values ranged from 4.3 MPa to
B 10.7 MPa (Table IV). Although those
B seem to be low bond strength values,
B the procedure for cutting the Y-TZP-
bonded beams adds a signicant
B
amount of tension to the adhesive
B
interface due to some uncontrolled vi-
B bration of the diamond blade, and
those values are in accordance with
C results reported by other authors.13,18
However, according to Luthy et al,7
the minimum bond strength required
to provide adequate clinical service and
de Souza et al
- 2014 5
100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%
48h 6m 48h 6m 48h 6m 48h 6m 48h 6m 48h 6m 48h 6m 48h 6m
Group PSB Group PCB Group PUL Group PCL Group SBU Group CBC Group UL Group CL

Type 1 Type 2 Type 3

1 Mode of failure presented by experimental groups at 48 hours and 6 months. Type 1

(adhesive at Y-TZP/resin interface), Type 2 (adhesive at composite/resin interface), or Type 3
(mixed failure). (Y-TZP, yttria-tetragonal zirconia polycrystal.)

longevity should be around 10 to 13
MPa.21
The rst null hypothesis (that MDP-
containing materials would have no
effect on bonding between Y-TZP and
composite resin substrate) was rejec-
ted, because the results showed that
an MDP-based adhesive system has a
signicant effect on bond strength
(P.001) (see Table II). Experimental
groups without the application of an
adhesive (groups PUL, PCL, UL, and
CL) presented signicantly lower bond
strength than groups with adhesive
application (groups PSB, PCB, SBU,
and CBC). Both adhesives (Scotchbond
Universal and Clearl S3 Plus) con-
tained some MDP in their formulation,
and, based on the EDS results, the
concentration of MDP was similar.
There was no control group with an
adhesive that did not contain MDP.
Therefore, determining the precise role
of MDP in adhesives on bond strength
values is not possible. Although MDP
seems to be a key molecule in chemical
bonding with the oxide layer,9 the
improved bond strength between Y-TZP
and composite resin substrates may
have been inuenced by the wettability

2 Photomicrography (group PCB, 48 hours) indicating Type 1 mode of failure. A, Y-TZP surface with few remaining spots of
Clearl SA resin. B, Composite resin substrate covered by Clearl SA resin. (Y-TZP, yttria-tetragonal zirconia polycrystal.)
de Souza et al
6 Volume - Issue -

3 Photomicrography (group SBU, 48 hours) indicating Type 3 mode of failure. A, RelyX Ultimate attached to Y-TZP surface.
B, Detailed view of fractured interface showing adhesive (star) and ller particles at the resin surface (arrow). (Y-TZP, yttria-
tetragonal zirconia polycrystal.)

promoted by the adhesive uid resin

on the Y-TZP surface. This wettability
reduces the contact angle between Y-
TZP and resin, which results in a more
intimate interaction between both. Kim
et al21 suggested that the surface energy
parameters of luting resins and the
contact angle between them and the
bonding substrate greatly affect bond
strength results.
The analysis of results between
initial (48 hours) and long-term (6
months water storage) bond strength
values found the signicant effect
of aging on bond strength to Y-TZP
4 Y-TZP carbon coated surface (control). (Y-TZP, (P<.001) (see Table III). Therefore,
yttria-tetragonal zirconia polycrystal.) the second null hypothesis was re-
jected. The 10-MDP acidic functional
monomer has been rated as relatively
2500 O Zr 2 hydrolysis stable because of its long
carbonyl chain.20 Furthermore, previ-
2000 Hf ous studies have reported stable
Zr bonding between resin and Y-TZP when
certain MDP-based treatments are
1500 C used.17,18 Therefore, the overall effect
Zr
of aging on bond strength was not ex-
1000 pected. The specimens in this study had
Hf a cross-sectional area of 1.0 mm2
maximum and were stored in water
500 Hf
for 6 months at room temperature.
Zr
This severe aging procedure exposed
0 the small adhesive interface to water,
0 0.5 1 1.5 2 2.5 3 3.5 allowing the hydrolytic degradation of
Full Scale 2598 cts Cur sor : 1.363 (493 cts) keV the monomer2 and affecting the overall
5 Atomic composition evaluated by EDS analysis. bond strength values (48 hours, 8.9
(EDS, energy-dispersive x-ray spectroscopy.) MPa; 6 months, 6.4 MPa). The
The Journal of Prosthetic Dentistry de Souza et al
- 2014 7
phosphoric acid acrylate primer and
adhesive.1
In this study, the MDP-based experi-
mental primer contained 0.5% MDP in
an ethanol solution. The literature sug-
gests that MDP has great afnity to
metal oxides9 like zirconium dioxide
(ZrO2). The application of certain
primers may also reduce the contact
angle between zirconia and resin and,
therefore, improve bond strength.16
However, the results indicated that the
application of the MDP-based primer
was not a signicant factor in bonding to
Y-TZP specimens (P.149). These re-
6 Y-TZP surface treated with MDP primer and coated with sults are in agreement with previous
carbon. (Y-TZP, yttria-tetragonal zirconia polycrystal; MDP, studies that suggested that the only
10-methacryloyloxydecyl dihydrogen phosphate.) primer agent capable of promoting
high bond strength to Y-TZP is
Alloy Primer (Kuraray), which has MDP
Zr 1 and 6-(4-vinylbenzyl-n-propyl)amino-
O
1,3,5-triazine-2,4 dithiol (VBATDT) in
2500
its composition.18 The application of
another commercial primer with only
2000 C Hf
Zr
MDP (Epiguard primer; Kuraray)
achieved only half of the bond strength
1500
Zr values presented by Alloy Primer-treated
specimens.17
1000 An analysis of the results found that
Hf
the application of either an MDP-
500 Hf
Zr containing resin or an MDP-free resin
did not have a signicant effect on
0 bonding between Y-TZP and composite
0 0.5 1 1.5 2 2.5 3 3.5
Full Scale 2969 cts Cur sor : 1.363 (455 cts) keV
resin (P.059). MDP, which is part of
the Clearl SA resin, has 2 functional
7 Atomic composition evaluated by EDS analysis.
groups in its structural formula. One is a
(EDS, energy-dispersive x-ray spectroscopy.)
divalent phosphoryl group, and the
other is a methacryloyl group. The diva-
degradation of the zirconia-resin inter- that the chemical bonding obtained lent phosphoryl group may be adsorbed
face is demonstrated by an increase in with MDP- and no-MDP-containing into zirconia, whereas the methacryloyl
the Type 1 mode of failure after aging composite resin/Y-TZP interfaces was can copolymerize with other monomers
(48 hours, 55.5%; 6 months, 68%; see not stable and should therefore be in the adhesive system used.19 RelyX Ul-
Fig. 1). Although no relationship has combined with methods that promote timate, in contrast, has no functional
been proven between the aging of the micromechanical interlocking as a way monomer in its composition, and
prostheses/tooth luting interface in the to ensure retentiveness. The combina- therefore does not improve chemical
mouth and microtensile aged bond tion of chemical and mechanical treat- bonding to Y-TZP ceramics.2 Clearl SA
strength data, lengthy storage in water ment has already been evaluated by was then expected to present higher
is a valuable method of evaluating the several authors, and the results are bond strength results as observed by
stability of the bond.2 Bond stability is controversial.4,10,12,13 For instance, a Koizumi et al,19 but this was not so. The
clinically stressed by other biologic 60-month clinical study found that similar results of Clearl SA and RelyX
agents, for example, acid compounds zirconia-based cantilevered single- Ultimate may have been inuenced by
in dentinal uids, oral bacteria, pro- retainer prostheses treated with the rheology of the Clearl SA resin,
teolytic residues, and salivary enzymes, airborne-particle abrasion and cemen- which is notably more viscous than
when an indirect restoration is in func- ted with an MDP-based resin per- RelyX Ultimate. As discussed in other
tion.8,13 The present ndings indicate formed similarly to those treated with a studies, viscosity, wetting capacity, and
de Souza et al
8 Volume
variations in chemical composition and
mechanical properties may play an
important role in the bonding capacity
to Y-TZP ceramics.7,24
The EDS analysis was performed to
help understand the role of MDP on the
chemical bonding between materials
and Y-TZP. Based on the characteristics
of the molecule, phosphorus and carbon
were considered indicators of the pres-
ence of MDP in the materials compo-
sition. When primer, adhesive, and resin
were combined and evaluated, the as-
sociation of Scotchbond Universal and
RelyX Ultimate resulted in higher peaks
of carbon and phosphorus than when
Clearl S3 and Clearl SA were evalu-
ated. The variation in the peaks was not
expected, given that both adhesives
presented similar peaks of phosphorus
and the application of a uid resin lm
on top of the resin would supposedly
shield the MDP underneath. More sen-
sitive analysis must be performed to
identify the chemical interaction be-
tween MDP-containing adhesives and
the resin layer underneath.
In the present research, Y-TZP speci-
mens were bonded to composite resin
substrates. When Y-TZP crowns are
clinically cemented, they are generally
bonded to the tooth structure (mostly
dentin) or to a foundation material,3
composite resin being the most fre-
quently used. Composite resin was
used in this study because, besides sim-
ulating a clinical procedure, the weak link
of the bonding would be at the interface
of interest, the Y-TZP/resin interface. If
dentin disks had been tested, experi-
encing the bond strength failure between
dentin and resin interface would have
been possible, and the denitive bond
strength values would be related to the
bond strength between resin and dentin.
The very low incidence of the Type 2
mode of failure (see Fig. 1; adhesive
between composite resin and resin)
suggests that the interface of interest
(Y-TZP/resin) was indeed evaluated.
CONCLUSIONS
Within the limitations of this in vitro
study, the application of an MDP-
The Journal of Prosthetic Dentistry
containing adhesive onto a Y-TZP non-
airborne-particle-abraded surface im-
proved the bond strength between Y-TZP
and composite resin substrate. Bonding
to non-airborne-particle-abraded Y-TZP
ceramic was not stable after 6 months of
water storage.
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Corresponding author:
Dr Grace de Souza
Faculty of Dentistry, University of Toronto
124 Edward St Room 352E
Toronto, ON, M5G 1G6
CANADA
E-mail: grace.desouza@dentistry.utoronto.ca
Copyright 2014 by the Editorial Council for
The Journal of Prosthetic Dentistry.
de Souza et al