In Vitro Evaluation of Bond Strength between Zirconia Core

and CAD/CAM-Produced Veneers

Merve Çakırbay Tanış, DDS, PhD,1 Mehmet Ali Kılıçarslan, DDS, PhD,2 & İbrahim Berk Bellaz, DDS, PhD3
1
Department of Prosthodontics, Faculty of Dentistry, Gazi University, Ankara, Turkey
2
Department of Prosthodontics, Faculty of Dentistry, Ankara University, Ankara, Turkey
3
Department of Prosthodontics, Faculty of Dentistry, Yeniyüzyıl University, İstanbul, Turkey

Keywords
CAD/CAM; produced veneers; veneering
methods; zirconia.
Correspondence
Merve Çakırbay Tanış, Gazi Üniversitesi Diş
Hekimliği Fakültesi Protetik Diş Tedavisi
Anabilim Dalı, Emek, Ankara, Turkey. E-mail:
mervec_@hotmail.com
A part of this manuscript has been presented
as an oral presentation at the 41st Annual
Conference of the European Prosthodontic
Association September 28–30, 2017,
Bucharest, Romania.
The authors deny any conflicts of interest
regarding this study.
Accepted April 25, 2019
doi: 10.1111/jopr.13068
Abstract
Purpose: To evaluate the shear bond strength between various CAD/CAM veneer
materials and the zirconia ceramic core.
Materials and Methods: Ninety square prism zirconia specimens (10 specimens
per each group, n = 10) in dimensions of 10 × 5 × 5 mm were prepared. Eighty
square prism veneering specimens (40 feldspathic ceramic [Cerec Bloc] and 40 lithium
disilicate [IPS e.max CAD]) in dimensions of 3 × 3 × 1 mm were connected to zirconia
specimens. Conventional layering was applied to the remaining zirconia specimens as
control group (n = 10). CAD/CAM-produced veneers were connected to the zirconia
specimens using fusion porcelain or resin cement. One of following treatments were
applied to the cemented specimens: no surface treatment, HF etching of the veneering
material, or HF acid etching of the veneer in combination with the application of a
glaze layer to the zirconia surface. Following the veneering procedures, a shear bond
strength test was performed at a speed of 1 mm/min using a universal testing machine.
Univariate ANOVA (α = 0.05) was performed for statistical analyses of the obtained
data.
Results: Statistically significant differences were not found among the materials (F =
0.176, p = 0.656), while statistically significant differences were found amongst the
veneering procedures (F = 57.921, p < 0.001). Statistical differences were observed
between the groups (F = 13.766, p < 0.001). The highest shear bond strength values
were observed in IPS e.max CAD specimens connected to zirconia with low fusion
porcelain (27.11 ± 7.7 MPa), and the lowest values were observed in IPS e.max CAD
specimens connected to zirconia with resin cement without surface treatment (9.82 ±
2.8 MPa). The application of fusion porcelain with IPS e.max CAD (p = 0.967) and
Cerec Blocs (p = 1.00) showed statistically similar results to those with conventional
layering.
Conclusions: The application of fusion porcelain to bond zirconia and digitally
produced veneering material can serve as an alternative veneering method to the
conventional layering method by accelerating and facilitating clinical and laboratory
stages.

Zirconia ceramics are generally preferred for fabricating all-
ceramic restorations because of their chemical stability and
physical and mechanical properties.1 They have superior me-
chanical properties compared to those of all other ceramic
systems2,3 due to a transformation toughening mechanism.4
Zirconia has 900 to 1200 MPa flexural strength and 9 to 10
MPa fracture toughness,2-4 making it strong enough to be re-
sistant to high occlusal stresses.3
Although zirconia-based restorations have superior mechan-
ical and esthetic properties, they are also associated with
some clinical complications.5 Chipping of veneering porce-
lain is the most frequent reason for failure of zirconia-based
restorations.6,7 Potential factors leading to veneer chipping are
type of veneering material, thickness of the veneer, insufficient
core support of the veneering ceramic, and sensitivity of the
fabrication process.8 However, chipping is generally attributed
to insufficient bond strength between veneering porcelain and
zirconia frameworks.4 Bond strength is affected by many fac-
tors, such as surface treatment of the framework, defects at the
core/veneer interface, residual stress due to thermal mismatch

Journal of Prosthodontics 0 (2019) 1–6 

C 2019 by the American College of Prosthodontists 1
Bond Strength between Zirconia and CAD/CAM Veneers
between the core and veneering porcelain, wetting properties of
the surface and reactions at the interface between substances.4
Various surface conditioning methods, such as grinding, sand-
blasting, tribochemical silica coating, acid etching, and laser
irradiation have been used to establish a stronger bond between
the zirconia core and veneering porcelain.9 Air abrasion is the
most common surface treatment used to roughen the zirconia
surface.10
The translucency of zirconia restorations is lower than that
of other ceramic materials due to their high crystalline con-
tent, grain dimensions, and thickness.11 To obtain more es-
thetic restorations, zirconia frameworks are generally veneered
with a ceramic material.12-14 The common veneering method
used for zirconia restorations is the layering method.1,15 This
method requires skill and multiple firings,13 and its disadvan-
tages include a lack of shade uniformity, formation of micro-
gaps, and reliance on the varying skill of dental technicians.
To overcome these disadvantages, additional veneering meth-
ods such as pressing and use of CAD/CAM-produced veneers
were developed.14 The application procedure of CAD/CAM-
produced veneers is based on a combination of a zirconia
core and a CAD/CAM-fabricated veneering ceramic through
firing with fusion porcelain14,16-21 or bonding with resin
cement.14,15,22,23 CAD/CAM-produced veneers result in less
chipping and failure, reduced time for fabrication, and reduced
firing compared to the layering method. Also, CAD/CAM-
produced veneers exhibit reduced porosity and flaws. Surface
porosity and surface flaws can lead to failure of the porcelain.16
Various CAD/CAM restorative materials, consisting mostly
of different ceramics, composite resins, and acrylic resins are
available.24 To predict the clinical success of the different com-
mercially available CAD/CAM veneer materials, in vitro eval-
uations may be beneficial and could lead to more appreciable
clinical studies. Although several studies have evaluated the
bond strength of CAD/CAM-produced veneers to zirconia core,
studies comparing various cemented and fused CAD/CAM-
produced veneers to zirconia core are limited. Also, information
about the effect of various surface treatments in combination
with the use of CAD/CAM-produced veneers needs to be de-
termined. The purpose of this study was to evaluate the shear
bond strength between 2 digitally produced veneering materials
and zirconia ceramic by connecting with resin cement or fusion
ceramic and the effect of HF acid treatment and glaze layer ap-
plication on bond strength when using resin cement. The null
hypotheses of this study were that use of CAD/CAM-produced
veneers would show similar shear bond strength to zirconia core
with conventional layering, and that use of different veneering
materials (feldspathic or lithium disilicate ceramic) or surface
treatments (acid etching, application of glaze layer) would not
affect bond strength to zirconia core.
Materials and methods
The materials used in this study are listed in Table 1. Zirconia
specimens were subjected to 2 veneering procedures: layer-
ing as control or application of CAD/CAM-produced veneers.
Two materials were used as CAD/CAM-produced veneers: IPS
e.max CAD or Cerec Bloc. CAD/CAM-produced veneers were
connected to zirconia specimens using resin cement or low-
2 Journal of Prosthodontics 0 (2019) 1–6 
Çakırbay Tanış et al
fusing porcelain. Resin cemented specimens were divided into
3 groups according to surface treatment applied: no surface
treatment, acid etching of the veneer, or acid etching of the
veneer combined with application of glaze layer to the zirconia
surface. Nine groups were formed in total. To determine sam-
ple size, a power analysis was performed. The sample size for
9 groups with 85% power, 95% confidence level (α = 0.05),
4.5% standard deviation, and 8 MPa significance level was 10.
So, sample size for each group was determined as 10 (n = 10).
Preparation of zirconia specimens
Pre-sintered zirconia blocks (APW02 Zir Dental) were sliced
under water cooling using a low-speed diamond saw (Microcut
201; Metkon; Bursa, Turkey) considering a 20% to 25% sinter-
ing shrinkage. The sintering process was conducted in a special
firing oven (Programat P510; Ivoclar Vivadent).
Ten zirconia specimens per group (n = 10), for a total of
90 square prism specimens, were prepared. The final dimen-
sions of the specimens were 10 × 5 × 5 mm. The dimension
of each specimen was checked with a digital caliper (Mahr,
GmbH, Esslingen, Germany). To obtain standardized speci-
men surfaces, the veneering surface of each specimen was
polished with 600-grit silicon carbide paper (Metkon Gripo
2V; Bursa, Turkey). Then, the specimens were cleaned ultra-
sonically (Bransonic Ultrasonic Cleaner; Bransonic Ultrasonic
Corp., Danbury, CT) in distilled water for 10 minutes and air
dried.
Veneering procedures
Conventional layering ceramic (VITAVM R
9) was applied to
the zirconia surface as the control group (n = 10). Equal-
thickness, square prism-shaped specimens in dimensions of 3
× 3 × 1 mm were prepared using a metal mold. The metal mold
was placed on the upper surface of the zirconia specimens, and
ceramic material was built up manually according to the manu-
facturer’s instructions by an experienced dental technician. The
top surface was flattened using a cement glass. Considering the
shrinkage of the porcelain, all specimens were subjected to
the sintering process twice. The thickness of all specimens was
confirmed with a digital caliper (Mahr, GmbH). If a thicker area
was present, the excess ceramic was removed with the help of
1200-grit silicone carbide abrasives (Metkon Gripo 2V).
Two CAD/CAM ceramic materials, feldspathic ceramic
(Cerec Bloc) and lithium disilicate glass-ceramic (IPS e.max
CAD) were applied to the remaining zirconia specimens. Ten
veneering specimens per each group (n = 10; 40 total Cerec
Blocs, 40 total IPS e.max CAD specimens) were prepared.
CAD/CAM blocks of each veneering material were prepared
according to the manufacturers’ instructions. The specimen de-
sign was made by 3D Builder (Microsoft Corp., Redmond,
WA), converted into an STL file, and fabricated with Cerec
inLab MC X5 (Sirona Dental Systems, Bensheim, Germany).
IPS e.max CAD specimens were submitted to the crystalliza-
tion process according to the manufacturer’s instructions. The
final dimensions of each veneering specimen were 3 × 3 ×
1 mm. All veneering ceramic specimens were then cleaned
ultrasonically in distilled water for 10 minutes and air dried.
C 2019 by the American College of Prosthodontists
Çakırbay Tanış et al Bond Strength between Zirconia and CAD/CAM Veneers

Table 1 Materials used

Material Manufacturer Batch number

Zirconia APW02 Zir Dental; Aidite, Qinhuangdao, China 150209-1

Conventional feldspathic ceramic VITA VM R
9; VITA Zahnfabrik, Bad Sackingen, Germany 0124
Cerec Blocs VITA Zahnfabrik, Bad Sackingen, Germany 60710
IPS e.max CAD Ivoclar Vivadent AG, Schaan, Liechtenstein R51558
RelyX Ultimate Clicker 3M GmbH, Neuss, Germany 633377
Low-fusion porcelain Vision Zirkon; Wohlwend AG Dental Manufacturer, Schellenberg, Liechtenstein 1529
Hydrofluoric acid Bisco Porcelain Etchant; BISCO Inc., Schaumburg, IL 1600005709
Adhesive Single Bond Universal Adhesive; 3M GmbH, Neuss, Germany N923265
Glaze Vita Akzent Plus Glaze Powder; Vita Zahnfabrik, Bad Sackingen, Germany 63500
Vita Akzent Plus Glaze Powder Fluid; Vita Zahnfabrik, Bad Sackingen, Germany 77150

The CAD/CAM-produced veneers were produced by bond-
ing veneering material to zirconia with resin cement (RelyX Ul-
timate Clicker) or applying fusion porcelain (Vision Zirkon). A
small amount of resin cement or fusion porcelain was placed on
the middle of the zirconia surface and vibrated for 10 seconds
(Vibrobaby SL; Bego, Bremen, Germany). Then the veneering
specimen was placed on the zirconia core by application of a 50
N load. For cemented specimens, excess cement was cleaned
and light cured on 2 opposite sides for 20 seconds (Elipar S10;
3M GmbH). Single Bond Universal Adhesive was applied to
the zirconia specimens before cementation procedure. For fused
specimens, excess porcelain was removed with a hand instru-
ment, and the specimen was gently placed in a ceramic furnace
(Programat P510; Ivoclar Vivadent) and fired with 450°C start
temperature, 45°C/minute heating rate, and end temperature of
770°C (for 1 minute before cooling started). Resin-cemented
specimens were cemented using one of 3 surface treatments
as follows: without any surface conditioning, 4% hydrofluoric
(HF) acid (Bisco Porcelain Etchant) etching of the bonding in-
terface of the veneering material for 20 seconds, or HF acid
etching of the bonding interface of the veneering material in
combination with the application of a glaze layer (Vita Akzent
Plus Glaze) to the zirconia surface. Glaze layer was applied as
follows: glaze powder was mixed with mixing liquid. A thin
glaze layer was applied to the zirconia surface with the help of
a ceramic brush and placed in the porcelain furnace. The heat
treatment program started at 500°C with 4-minute preheating.
Then the temperature was raised by 80°C/minute. Specimens
were kept at the final temperature of 950°C for 1 minute before
cooling started. The glaze layer was acid etched for 60 seconds
and rinsed for 90 seconds. Veneering specimens subjected to
HF etching were washed under running water and then gently
dried before cementation.
Shear bond strength test and statistical
analyses
After the veneering procedures, a shear bond strength test
was performed using a universal testing device (Lloyd-LRX;
Lloyd Instruments, West Sussex, UK) at a crosshead speed of
1 mm/min and a preload of 10 N. The knife tip of the universal
test device was positioned at the bonding interface between zir-
conia and veneering ceramic. Shear bond force was recorded
in Newtons, and the average shear bond strength (MPa) was
calculated by dividing the load (N) at which failure occurred
by the bonding area (mm2 ).
The data were statistically analyzed by univariate ANOVA
(α = 0.05; SPSS 11.0 for Windows; SPSS Inc., Chicago, IL)
considering the following factors: material (3 levels: e.max,
Cerec, Vita), veneering procedure (3 levels: layering, resin
cement, low fusion), surface treatment (3 levels: none, acid,
glaze). Additional post-hoc tests (Tukey HSD) were performed
for multiple comparisons between the groups; p-values <0.05
were considered statistically significant in all tests.
Results
The maximum, minimum, and mean shear bond strength
values and statistical differences are presented in Table 2.
There was no statistically significant difference among the
veneering materials (F = 0.176, p = 0.656). Statistically
significant differences were found among the veneering
procedures (F = 57.921, p < 0.001), surface treatments
(F = 11.885, p < 0.001) and interaction between material and
veneering procedure parameters (F = 4.050, p = 0.047). In
addition, interaction between material and surface treatment
parameters (F = 2.073, p = 0.132) did not show statistical dif-
ference. Interactions between the groups showed statistically
significant differences (F = 13.766, p < 0.001).
The highest shear bond strength values were observed in
IPS e.max CAD specimens fused to zirconia core (27.11 ±
7.7 MPa), while the lowest were observed in cemented IPS
e.max CAD specimens without surface treatment (9.82 ±
2.8 MPa). Cemented Cerec Bloc specimens with acid etching
(p = 0.375), fused Cerec Bloc specimens (p = 1.0), cemented
IPS e.max CAD specimens with acid etching (p = 0.727), and
fused IPS e.max CAD specimens (p = 0.967) showed statis-
tically similar shear bond strength values compared to those
of layered (control). Cemented Cerec Bloc specimens without
surface treatment (p = 0.02), cemented Cerec Bloc specimens
with glaze application (p < 0.001), cemented IPS e.max CAD
specimens without surface treatment (p < 0.001), and cemented
IPS e.max CAD specimens with glaze application (p < 0.001)
showed lower bond strength values compared to those of the
control group.

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Bond Strength between Zirconia and CAD/CAM Veneers
Table 2 Maximum and minimum shear bond strength values and mean shear bond strength values (MPa) and standard deviations (SD)
Min shear bond
Veneering procedure strength values
Vita, Layering 9.94
Cerec Bloc, resin cement, no surface treatment 13.17
Cerec Bloc, resin cement, acid etch 12.5
Cerec Bloc, resin cement, glaze layer 8.00
Cerec Bloc, fusion porcelain 18.54
IPS e.max CAD, resin cement, no surface treatment 5.93
IPS e.max CAD, resin cement, acid etch 10.94
IPS e.max CAD, resin cement, glaze layer 6.24
IPS e.max CAD, fusion porcelain 20.19
*Different superscript letters describe statistical differences in the shear bond strength test (p < 0.05).
Discussion
This study evaluated the shear bond strength achieved with
CAD/CAM-produced veneers compared to conventional layer-
ing. The hypothesis established was partially accepted. Veneer-
ing procedure and surface treatments affected the bond strength
between zirconia and resin cement, while the type of veneering
material had no effect. The groups subjected to the same veneer-
ing procedure with the surface preparation (resin + no surface
treatment, resin + HF etching, resin + application of a glaze
layer or low-fusing porcelain) showed no statistical differences
according to the materials used. CAD/CAM produced veneers
fused to zirconia core resulted in similar bond strength values
compared to those with conventional layering. According to
the results of this study, fused CAD/CAM produced veneers
can serve as an alternative veneering procedure to conventional
layering.
A standard test method for evaluating the bond strength of
ceramic materials has not yet been determined.2,25 Several test
methods, including the shear bond strength test, the microten-
sile bond strength test, 4-point loading tests, and the biaxial
flexural strength test, are used to evaluate core veneer bond
strength.11,12 All of these methods have some advantages and
disadvantages.12 The shear bond strength test was used in this
study because of its easy application procedure and simple
specimen design. Additionally, more standardized data are ob-
tained by the shear bond strength test.1 Stresses that occur
during the shear bond strength test are mainly directed to the
bond interface, resulting in a uniform stress distribution at the
bond interface.2 However, factors such as specimen type and
preparation method, load application rate, and researcher’s ex-
perience should be considered when applying a shear bond
strength test.12
Various veneering methods, such as conventional layering or
pressing, are used for veneering zirconia cores.18 In layered ce-
ramic restorations, the core veneer bond strength is insufficient
due to stresses occurring at the interface because of thermal co-
efficient differences, firing shrinkage, and the rate of increasing
and decreasing temperature. Differences between the thermal
properties of materials can cause stress in layered restorations
during heating and cooling cycles.26 In addition, the layering
method requires substantial time and can lead to problems re-
4 Journal of Prosthodontics 0 (2019) 1–6 
Çakırbay Tanış et al
Max shear bond Mean shear bond
strength values strength values ± SD
41.84 24.23 ± 9.8a,b
20.49 15.29 ± 2.2c,d,e
24.74 18.47 ± 3.7b,c,d
14.98 10.76 ± 2.5d,e
33.1 25.35 ± 5a,b
13.33 9.82 ± 2.8e
29.52 19.83 ± 6.5a,b,c
26.7 10.97 ± 5.9d,e
43.28 27.11 ± 7.7a
lated to the skill of the dental technician, such as structural
defects in the veneer, occlusal misfits or shade, and esthetic
disharmony.27 With the CAD/CAM produced veneers, restora-
tions closer to natural teeth in shape and color can be fabricated
with minimum firing.16 The CAD/CAM-produced veneers al-
low operator-dependent steps, such as impression, modeling,
and finishing, to be completed by computer-controlled design
and fabrication,28 thus leading to the desired shade, translu-
cency, and strength.27 The use of CAD/CAM blocks, which are
manufactured by industrial pressing, results in a homogenous
structure and a fast fabrication procedure.28 The control group
(layering) in this study was hand produced, meaning there was
a human-related factor, which can affect the results. There-
fore, a mold was used for standardized specimen fabrication,
and a digital caliper was used to control the final thickness
of each specimen. Also, the specimens were fabricated by an
experienced technician to minimalize the fabrication-sourced
differences between each specimen.
Previous studies comparing the use of fused CAD/CAM-
produced veneers and the layering method reported higher frac-
ture strength values with CAD/CAM-produced veneers,28-31
potentially indicating a stronger bond between zirconia core
and veneering ceramic. In addition, Kanat et al28 and Kim et
al32 reported higher bond strength values with CAD/CAM-
produced veneers compared to those with layering. In this
study, fused IPS e.max CAD and Cerec Blocs specimens re-
sulted in statistically similar bond strength values (Vita: 24.23
MPa, Cerec Blocs: 25.35 MPa, IPS e.max CAD: 27.11 MPa)
to those with conventional layering. The dissimilar results ob-
tained in this study can be due to different brands of zirconia,
veneering ceramic, or fusing porcelain, and different test pa-
rameters such as test method or bonding area width used in this
study.
Al-Wahadni et al14 reported lower fracture resistance and
adhesive failures at the core/veneer interface with CAD/CAM-
produced veneers compared to layering. They attached the ve-
neering material (Vita TriLuxe forte) and the zirconia core
with resin cement (Panavia F2.0). Schmitter et al23 also re-
ported that CAD/CAM veneers cemented to zirconia showed
lower fracture resistance than the layered veneers. The results
of this study are consistent with the previous reports. Veneering
materials cemented to zirconia with no surface treatment and
C 2019 by the American College of Prosthodontists
Çakırbay Tanış et al
those that underwent surface treatment through application of a
glaze layer showed lower bond strength compared to that with
conventional layering; however, etching the veneering mate-
rial surface with HF acid yielded increased bond strength and
showed statistically similar results to layering.
Resin bonding of IPS e.max CAD and Cerec Bloc veneers
with no surface treatment or with the application of glaze layer
showed statistically lower shear bond strength values compared
to fused veneers. Additional etching with HF acid and resin
bonding of the IPS e.max CAD resulted in similar shear bond
strength values compared to those with the application of low-
fusing porcelain. Low-fusing porcelain forms a stronger and
more homogenous bond than resin cement due to higher flex-
ural strength.14 Use of a relatively weak resin cement layer to
connect the veneer and the core can lead to increased tensile
stress inside the veneering material.14 The use of resin cements
in intraoral conditions can result in failure due to mechanical
and thermal stresses and saliva. Additionally, resin cement can
become discolored over time.23
Application of a glaze layer at the zirconia and resin cement
interface has been used in previous studies,33-37 and some stud-
ies reported increased bond strength values.36,37 In this study, a
glaze layer was applied to enhance the bond between the zirco-
nia and CAD/CAM-produced veneering materials when resin
cement was used. Cura et al34 reported lower bond strength
values by applying a glaze layer. In addition, Usumez et al33
reported that glaze layer application did not result in increased
bond strength between the zirconia and resin cement compared
to that in the control group. The results of this study are similar
to those studies.
This study has some limitations. The specimens used in this
study had flat surfaces and do not reflect the clinical crown
shape. Flat specimens were used to provide more standard
study design; however, this can affect the results, as the sur-
face geometry of the specimens does not simulate the clinical
crown. No thermal or mechanical aging process was applied
in this study, so the obtained results cannot be generalized to
long-term clinical use. Also, only one type of resin cement was
used in this study. Use of different resin cements can affect
the results. Further studies evaluating the effect of different
resin cements on the bond strength of CAD/CAM veneers are
needed. Although in vitro studies and laboratory conditions
provide more standardized specimens, in vivo studies are also
required.
Conclusions
CAD/CAM-produced feldspathic (Cerec Bloc) or lithium dis-
ilicate glass-ceramic (IPS e.max CAD) veneers fused to zirco-
nia core showed statistically similar results with conventional
layering. Application of these materials to zirconia core by us-
ing low-fusion porcelain can serve as an alternative veneering
method to the conventional layering method. Using a combi-
nation of resin cement and a glaze layer to connect the ve-
neering material and zirconia core is not recommended, as it
showed lower bond strength than conventional layering. Acid
etching of IPS e.max CAD veneers is recommended, as it is an
Journal of Prosthodontics 0 (2019) 1–6 
C 2019 by the American College of Prosthodontists
Bond Strength between Zirconia and CAD/CAM Veneers
easy application step increasing the bond strength to zirconia
core.
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C 2019 by the American College of Prosthodontists