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Panavia F 2.0 bonding to contaminated zirconia


ceramic after different cleaning procedures

A.C. Quaas a , B. Yang b , M. Kern b,∗


a Department of Prosthodontics, School of Dentistry, Albert-Ludwigs University, Freiburg, Germany
b Department of Prosthodontics, Propaedeutics and Dental Materials, School of Dentistry, Christian-Albrechts University, Kiel, Germany

a r t i c l e i n f o a b s t r a c t

Article history: Objectives. The purpose of this laboratory study was to evaluate the influence of different
Received 18 April 2005 cleaning methods after saliva contamination and after using a silicone disclosing medium
Received in revised form on the resin bond strength to zirconia ceramic. The hypothesis was that the resin-ceramic
6 March 2006 bond strength and its durability are related to the ceramic surface condition.
Accepted 8 March 2006 Methods. Plexiglas tubes filled with composite resin were bonded to air-abraded zirconia
ceramic disks using a phosphate monomer containing composite resin. Four surface clean-
ing methods were used after contaminating the ceramic surface: air abrasion with 50 ␮m
Keywords: Al2 O3 at 2.5 bar pressure for 15 s, cleaning with 37% phosphoric acid for 60 s once or for 30 s
Bond strength twice, or cleaning in 96% isopropanol for 15 s. The specimens of the control group were not
Cleaning methods cleaned after using the silicone disclosing medium. For each combination 16 specimens
Cercon were bonded in an alignment apparatus. Subgroups of eight bonded specimens were tested
Air abrasion for tensile bond strength (TBS) after storage for either 3 or 150 days combined with 37,500
Zirconia ceramic thermal cycles. The statistical analyses were performed with the Kruskal–Wallis test, fol-
Panavia F 2.0 lowed by multiple pair-wise comparisons using the Wilcoxon rank sum test.
Silicone disclosing medium Results. The mean TBS ranged from 6.6 to 49.9 MPa after 3 days and from 0 to 19.8 MPa after
Fit checker 150 days. Air abrasion of the ceramic surface provided statistically significantly higher bond
strengths than the other cleaning methods after 3 and 150 days. Alcohol cleaning of the
ceramic did not provide durable bond strengths over time.
Significance. Ceramic cleaning methods after try-in procedures have a significant influence
on the resin-ceramic bond strength. Air abrasion of contaminated zirconia ceramic is the
most effective.
© 2006 Published by Elsevier Ltd on behalf of Academy of Dental Materials. All rights reserved.

1. Introduction bonded fixed partial dentures [3–5] and all-ceramic crowns


[6,7].
The adhesive cementation of all-ceramic restorations is Recently, a number of zirconium oxide ceramic systems
widely accepted for clinical use and bonding of luting resin have been introduced including Cercon (DeguDent, Germany),
to ceramic has improved significantly over the last decade. LAVA (3M ESPE, Germany) and Procera AllZirkon (NobelBio-
Various clinical and laboratory studies document the success care, Sweden). Full-coverage zirconia ceramic restorations and
of long-term resin bond to dental ceramics, such as porce- FPDs may not require adhesive cementation [8]. However, a
lain laminate veneers [1], ceramic inlays and onlays [2], resin- durable resin bond to ceramic is necessary in some special


Corresponding author. Tel.: +49 431 5972874; fax: +49 431 5972860.
E-mail address: mkern@proth.uni-kiel.de (M. Kern).
0109-5641/$ – see front matter © 2006 Published by Elsevier Ltd on behalf of Academy of Dental Materials. All rights reserved.
doi:10.1016/j.dental.2006.03.008
d e n t a l m a t e r i a l s 2 3 ( 2 0 0 7 ) 506–512 507

clinical situations, such as compromised retention and short methods after saliva contamination and after using a silicone
abutment teeth [9] or for resin bonded FPDs [4,5,10]. High- disclosing medium on the resin-ceramic bond strength of an
strength ceramic materials such as zirconium oxide-based adhesive bonding system to zirconia ceramic. The study was
ceramics require alternative bonding techniques to achieve a designed to test the hypothesis that the resin-ceramic bond
long-term durable resin-ceramic bond because conventional strength and its durability are related to the cleaning meth-
hydrofluoric etching has no positive influence on the bond ods of the contaminated ceramic bonding surface.
strength [11]. Compared with silica-based ceramics, in the
literature only a few studies regarding bonding methods to
zirconium oxide ceramics have been published. These studies 2. Materials and methods
suggest the use of resin cements that contain special adhesive
monomers [12–16]. Disk-like specimens were made from the zirconia ceramic Cer-
All-ceramic restorations finished for cementation are usu- con (94% ZrO2 stabilised by 5% Y2 O3 , DeguDent, Germany,
ally already air-abraded from the dental laboratory. After the Batch No. 20009176). The disks had a diameter of 8 mm and
try-in of the restoration again, the ceramic surface might be a thickness of 3.4 mm. All specimens were polished with a
contaminated by saliva, blood or silicone fit-indicators. The rotating silicon carbide paper down to 600 grit and airborne
use of a silicone disclosing medium allows the dentist to particle abraded with 50 ␮m Al2 O3 at 2.5 bar pressure (15 s)
improve the fit of dental restorations by detecting interfer- at a distance of 10 mm at most, 1 h before bonding. After-
ence spots on the internal casting surfaces before cemen- wards, the specimens were immersed in saliva for 1 min.
tation. However, residual organic and silicone contaminants Saliva was collected from the first healthy author who had
may decrease bond strengths and should be removed from refrained from eating and drinking 1.5 h prior to the collec-
the surface before cementation. tion procedure. All experiments were performed using fresh
Saliva contamination of etched enamel is one of the most saliva collected at the same occasion. The specimens were fol-
frequent reasons for poor or failed bond strength. A recent lowed by water-spraying for 15 s and air-drying for another
study evaluated the effects of various saliva contamination 15 s. Then the specimens were pressed into the freshly mixed
periods on the surface topography of etched enamel sur- silicone disclosing medium (Fit Checker black, GC Corporation,
faces [17]. It could be shown that the salivary contaminant Tokyo, Japan) with finger pressure for 3 min. Because there
could be successfully removed by water-rinsing only when were no visible remnants after removing the black silicone
the salivary exposure time is less than 1 s. Salivary exposure fluid, the specimens were not cleaned with water spray. All
times of more than 1 s will lead to an adherent organic coat- specimens were cleaned using the following methods. Then a
ing that is not removed by conventional washing methods phosphate monomer modified composite resin (Panavia F2.0,
and it would be necessary to repeat the etching procedure. Kuraray, Osaka, Japan) was applied to the cleaned ceramic sur-
The effect of ceramic surface contamination with saliva and face. Four different ceramic cleaning methods were used after
the subsequent cleaning of the surface with phosphoric acid contamination and the following codes were assigned to the
was evaluated by Nicholls et al. [18]. Comparing two differ- groups:
ent surface cleaning methods, cleaning with phosphoric acid The specimens were classified into five experimental
showed higher bond strength values than cleaning with ace- groups according to the cleaning methods: air-abraded with
tone. However, the bond strength was evaluated without the 50 ␮m Al2 O3 at 2.5 bar pressure for 15 s at a distance of 10 mm
influence of long-term water storage and long-term thermal and then air cleaned with compressed air (group AIR); etched
cycling so that there is no indication for the bonding durabil- with 37% phosphoric acid for 60 s once, then rinsed with
ity. water spray for 15 s and dried for another 15 s (group PH1);
Szep et al. evaluated the influence of silicone disclosing etched with 37% phosphoric acid for 30 s twice and then water-
procedures on the shear bond strength of composite cements sprayed for 15 s and dried for 15 s (group PH2); immersed in
to industrially sintered (Cerec) and laboratory sintered (Duc- 96% isopropanol for 15 s and then rinsed with tap water for
eram) ceramic restorations after differently conditioning the 15 s (group ALC); or rinsed with tap water only (group CTR).
ceramic surface [19]. This study showed that etching the spec- Table 1 shows the composition of the used materials.
imens with 9.5% hydrofluoric acid (HF) for 60 s after using a Plexiglas tubes with an inner diameter of 3.2 mm were filled
fluid silicone did not lead to a significant reduction of the with auto-curing composite resin (Clearfil FII, Kuraray Med-
shear bond strength between ceramic and composite cement. ical Inc., Osaka, Japan). After 7 min from mixing, the filled
Another study found that the use of a silicone fit-indicator tubes were bonded with Panavia F 2.0 composite resin (Kuraray
significantly reduced the crown retention bonded with zinc Medical Inc., Osaka, Japan) to the ceramic surface using an
phosphate cement because of a residual silicone film remain- alignment apparatus under a load of 750 g [21]. The appa-
ing on the inner surface of the crown [20]. Cleaning with a ratus ensured that the tube axis was perpendicular to the
metal cleaner before cementation did not reverse the effect. surface (Fig. 1). After excess resin was removed, an air block-
Therefore, after the try-in of restorations in a patient’s mouth, ing gel (Oxyguard II, Kuraray Medical Inc., Osaka, Japan) was
they should be air-abraded with Al2 O3 before cementation. In applied around the bonding margins. The bonded specimens
short, after using a silicone disclosing medium, silicone rem- were light-cured for 20 s from two opposite sides with a den-
nants may decrease bond strengths and should be removed tal curing light machine (Optilux 500, Kerr, Danbury, USA),
from the surface before bonding. further cured in a light-curing unit (UniXS, Heraeus-Kulzer,
Therefore, the purpose of this laboratory study was to Wehrheim, Germany) for an additional 90 s, and placed at
evaluate the influence of different ceramic surface cleaning room temperature for 10 min, and then stored in 37 ◦ C water.
508 d e n t a l m a t e r i a l s 2 3 ( 2 0 0 7 ) 506–512

Table 1 – List of used materials and their characteristics


System Component Batch No. Main compositiona Manufacturer

Clearfil Base paste 01696 B BisGMA/TEGDMA/DMA/ Kuraray, Osaka, Japan


FII Catalyst paste 01597 B Barium sulphate/silica cont. composite

Panavia F2.0 A-paste 00037 A BPEDMA/MDP/DMA/ Kuraray, Osaka, Japan


B-paste 00020 A Ba–B–Si–glass/silica cont. composite
Oxyguard II 00471 A Polyethyleneglycol/glycerin gel

Cercon Base 38 20009176 ZrO2 (94%),Y2 O3 (5%), Al2 O3 (<1%),Si2 O3 (<1%) cont. ceramic DeguDent, Hanau, Germany
Fit Checker Base paste 0301161 Si cont. silicone GC Corporation, Tokyo, Japan
Black Catalyst paste 0301161 Sn cont. silicone

BisGMA, bisphenol-A-diglycidylmethacrylate; BPEDMA, bisphenol-A-polyethoxy dimethacrylate; DMA, aliphatic dimethacrylate; MDP, 10-
methacryloyloxy-decyl dihydrogenphosphate; TEGDMA = triethyleneglycol dimethacrylate, Al, aluminum; B, boron; Ba, barium; Si, silicium;
Sn, stannous; Zr, zirconium; Y, yttrium; cont., containing.
a
According to the information provided by the manufacturers.

For each combination 16 specimens were bonded. Sub-


groups of eight bonded specimens were stored in water (37 ◦ C)
3. Results
either for 3 days without thermal cycling or for 150 days with
37,500 thermal cycles from 5 to 55 ◦ C and from 55 to 5 ◦ C with The mean and standard deviation of tensile bond strengths
a dwell time of 30 s. The tensile bond strength was tested in (TBS) for the five cleaning groups and the two storage condi-
a universal testing apparatus (Zwick Z010/TN2A, Germany) at tions are shown in Table 2. Statistically significant differences
a crosshead speed of 2 mm/min using a chain loop alignment between the cleaning groups and the storage conditions are
which provided a moment-free axial application [21]. indicated in the same table. The Kruskal–Wallis test revealed a
The fractured interfaces on the zirconia ceramic speci- significant influence (p < 0.001) of the cleaning method used as
mens were examined using a light microscope (Wild M 420, well as of the storage times on the bond strength. The highest
Heerbrugg, Germany) at 30× magnification to calculate the bond strength was found for group AIR after 3 days ranging
debonded area and to assign failure modes as either adhe- from 40.4 to 61.4 MPa. It decreased statistically significantly
sive or cohesive. Representative samples were examined in a after storage time with thermal cycling ranging from 8.3 to
scanning electron microscope (SEM, XL 30 CP, Philips, Kassel, 26.2 MPa.
Germany) with an acceleration voltage of 15 KeV after sput- Cleaning with 37% phosphoric acid for 30 s twice (group
tering using a gold alloy conductive layer of approximately PH2) resulted in an initial bond strength ranging from 30 to
30 nm. Statistical analyses of the test results were performed 45 MPa. Storage led to a statistically significant decrease in ten-
by the Kruskal–Wallis test (p < 0.001) followed by multiple pair- sile bond strength (9–21.8 MPa).
wise comparisons of the groups using the Wilcoxon rank sum Cleaning with 37% phosphoric acid for 60 s once (group PH1)
test. led to lower bond strength values than group PH2, initially

Fig. 1 – Test configuration. Alignment apparatus (left), thermal cycling apparatus (middle), and self-aligning debonding jig
with upper and lower rings for chain suspension (right).
d e n t a l m a t e r i a l s 2 3 ( 2 0 0 7 ) 506–512 509

Table 2 – Tensile bond strength to zirconia ceramic after


surface contamination using four different cleaning
methods and two storage times. Medians, means and
standard deviations in MPa
Cleaning Storage time
method
3 days 150 days

Median Mean (S.D.) Median Mean (S.D.)

AIR 47.1 A␣ 49.9 (7.4) 20.9 A␤ 19.8 (5.3)


PH2 36.5 B␣ 37.2 (4.8) 14.1 B␤ 14.4 (4.0)
PH1 23.9 C␣ 23.6 (6.4) 11.5 B␤ 12.1 (4.4)
ALC 10.0 D␣ 8.2 (5.5) 0.0 C␤ 0.0
CTR 9.8 D␣ 6.6 (5.7) 0.0 C␤ 0.0

AIR, air-abraded with 50 ␮m Al2 O3 at 2.5 bar pressure (15 s); PH1,
cleaned with 37% phosphoric acid for 60 s; PH2, cleaned with 37%
Fig. 2 – Type of bonding failure mode as identified with a
phosphoric acid twice for each 30 s; ALC, cleaned in isopropanol
(96%); CTR, control group without cleaning. Storage time 3 days light microscope at 30× magnification and calculated in
was without thermal cycling, while storage time 150 days included percentage of the bonding area for all test methods after
37,000 thermal cycles. Within the same column, means with the different storage times. Group codes see Table 2.
same letter are not statistically different (p > 0.05). Within the same
row, means with the same Greek letter are not statistically different
p > 0.05. Global Kruskal–Wallis test followed by pair-wise compari-
son using the Wilcoxon test.
In groups ALC and CTC the failure modes were completely
adhesive for all specimens after 3 days and 150 days storage
time.
ranging from 14.7 to 32.2 MPa. It also decreased statistically SEM sample photographs of groups PH1 and PH2 demon-
significantly after storage time (7.4–20.4 MPa). strated a change in failure mode over storage time. After
The specimens cleaned in alcohol (group ALC) showed rel- storage over 150 days with thermal cycling, the failure mode
atively low initial bond strengths from 0 to 15.4 MPa. Three changed to mostly adhesive in group PH1 (about 60%), while
specimens debonded spontaneously during the storage of 3 in groups AIR and PH2 the portion of adhesive failures was
days. lower (about 25–50%). Figs. 3–5 show representative SEM pho-
No cleaning after contamination (group CTR) led to the low- tographs of the debonded ceramic surfaces after tensile test-
est bond strength values, initially ranging from 0 to 18.0 MPa. ing. The examination of typical samples in the SEM verified
After 3 days two specimens debonded spontaneously. During the failure modes detected with the light microscopic evalu-
the next 12 days storage time, all specimens of groups ALC ation (LM) in groups AIR, PH1 and PH2 (Figs. 3 and 4) and in
and CTR debonded spontaneously. Therefore, cleaning with groups ALC and CTR (Fig. 5).
alcohol and no cleaning in the control group resulted in a sta-
tistically significant decrease of bond strength compared to
the other cleaning methods after 3 and 150 days of storage
time, respectively.
Air abrasion of the zirconium oxide specimens with Al2 O3
increased the bond strength statistically significantly, but
it did not remain stable over storage time. Moreover, TBS
of group PH2 is statistically significantly higher than that
of group PH1 after 3 days storage. However, after 150 days
there was no statistically significant difference between TBS
of groups PH1 and PH2. In summary, the long-term stor-
age in water with thermal cycling led to a statistically
significant decrease in tensile bond strength for all test
groups.
The types of failure modes as assigned using the light
microscope at 30× magnification and calculated in percent-
ages of the bonding areas for all groups, are shown in
Fig. 2. Initially after 3 days of water storage the failure
mode was mostly cohesive in the tube filling composite Fig. 3 – Type of failure mode in group AIR after 3 days of
resin for groups AIR, PH1 and PH2. In group PH1 the per- storage time. A, very small part of adhesive failure from
centage of adhesive failure was about three times higher ceramic surface; C1, cohesive failure in Panavia F 2.0
than that in groups AIR and PH2. After 150 days storage composite resin cement; C2, cohesive failure in the tube
the percentage of adhesive failure increased in all groups. resin. SEM: 50× magnification.
510 d e n t a l m a t e r i a l s 2 3 ( 2 0 0 7 ) 506–512

Fig. 4 – (a) Type of failure mode in group PH1 after 150 days of storage time and TC. A, adhesive failure from ceramic
surface; C1, cohesive failure in Panavia F 2.0 composite resin cement; C2, cohesive failure in the tube resin. SEM: 50×
magnification. (b) Detailed magnification of (a) part A. Air-abraded ceramic surface with only minimal coatings, which
points at an adhesive failure mode. SEM: 4000× magnification. (c) Detailed magnification of (a) part C1. Organic matrix could
be seen, which points to a cohesive failure in the composite resin. SEM: 1000× magnification. (d) Detailed magnification of
(a) part C1. There are bubbles seen from mixing the tube resin. SEM: 1000× magnification.

The standard deviations, as shown in Table 2, are about


4. Discussion 15–20% for groups with high bond strength values and a high
percentage of cohesive failure (groups AIR and PH2 after 3 days
Storage time and cleaning methods have significant influ- of storage), which is acceptable with eight samples in each
ences on the bond strength of zirconia ceramic with Panavia group. For groups with lower bond strength values and a high
F 2.0. It is in good agreement with the completely adhesive percentage of adhesive failure, the standard deviations are a
failure modes of groups ALC and CTR after 3 and 150 days in little higher, which could be explained by the fracture phe-
comparison to groups AIR, PH1 and PH2 with a mixed failure. nomena at the surface area of the samples. In addition, in
The failure mode of groups AIR, PH1 and PH2 was mostly cohe- groups ALC and CTR some samples debonded spontaneously
sive after 3 days as indicated by light microscopic evaluation during storage time. So, the TBS values of these samples are
and confirmed in the SEM (Figs. 3 and 4). However after 150 0 MPa, which also increase the standard deviations of these
days storage, there was a large percentage of cohesive fail- groups.
ure (about 80%) only in group AIR. Therefore in this group the As the results of the present study show, it was not possi-
decrease in bond strength after water storage with thermal ble to achieve a durable long-term bond to the Cercon zirconia
cycling was not caused mainly by a decrease in adhesive bond ceramic without cleaning the surface after the use of a sili-
strength but by a decrease in cohesive strength of the luting cone disclosing medium and saliva immersion. All specimens
resin itself. without any cleaning (group CTR) showed low initial bond
d e n t a l m a t e r i a l s 2 3 ( 2 0 0 7 ) 506–512 511

systems, artificial aging methods and the surface conditioning


methods used in studies [22,23]. Only a few studies engag-
ing in the long-term resin bond to zirconia ceramics are cur-
rently available [14,15,24]. These studies confirm that a phos-
phate monomer containing composite resin is able to create
a durable chemical bond to metal-oxides such as aluminum
and zirconium oxide, which has already been stated years ago
[25]. In the present study conditioning the ceramic surface
with Al2 O3 was chosen as it was successfully used in other
studies, particularly concerning the long-term bond strength
of Panavia to zirconia ceramic [14,24,26].
The mean results of group AIR obtained in the present
study ranged from 40.4 to 61.4 MPa after 3 days, which con-
forms to the results of previous studies [14,15,24] with the
same test set-up after storage for 150 days with 37,500 TC using
Panavia 21 on zirconia ceramic. Similar results were found
Fig. 5 – Type of failure mode in group ALC after 3 days of using Panavia F to zirconia ceramic [27].
storage time. No coating on the air-abraded surface is However, in the present study there was a statistically
visible, which indicates a completely adhesive failure significant decrease for the air-abraded specimens after 150
mode. This picture is also representative for the completely days storage time by using the latest Panavia version labeled
adhesive failures in group CTR. SEM: 50× magnification. Panavia F 2.0. So, storage time with thermal cycling reduced
the cohesive strength of the composite resin itself because the
failure mode was still mainly cohesive. Such a degradation
strengths and debonded spontaneously within 12 days stor- within a composite resin itself has been previously shown to
age time. Cleaning with alcohol did not reverse this effect. The occur with other composite resins [28,29]. This phenomenon
bond strength values of group ALC were comparable to the had been explained by the negative effects of the water on the
results of group CTR. The failure mode was completely adhe- bonds between the resin matrix and the silanated fillers.
sive for groups ALC and CTR. Therefore, the silicone disclosing However in part, water ingress also seemed to diminish
medium and saliva used in the present study seem to have left the initial chemical bond of Panavia F 2.0 to zirconia ceramic
an invisible thin residual organic film on the ceramic surface in groups AIR, PH1 and PH2 as the fracture modes changed
that caused a dramatic decrease in bond strength in groups from primarily cohesive to a greater adhesive portion at the
ALC and CTR as compared to the other cleaning groups. The ceramic surface in these groups (Fig. 4a). Based on the results
silicone film remaining on the specimens might have acted as of the current study it might be concluded that Panavia F2.0
a lubricant, inhibiting stable micromechanical retention and is not completely hydrolytically stable and lost its cohesive
stable chemical bonds, and alcohol cleaning for 15 s was not strength during longer-term storage in water with thermal
effective to eliminate the silicon remnants and saliva on the cycling. Unfortunately, no other studies could be found in the
ceramic surface. literature testing the long-term bond strength of Panavia F2.0
Cleaning with 37% phosphoric acid for 60 s once (group to zirconia ceramic.
PH1) initially resulted in bond strength values ranging from
15 to 32 MPa. However, there was a significant decrease
5. Conclusions
after storage time with thermal cycling accompanied by an
increase in adhesive failure mode (nearly 60%). Initially the
Using a silicone disclosing medium and saliva immersion
Kruskal–Wallis test revealed statistically significantly higher
severely impeded resin bonding to zirconia ceramic, while
bond strength values of group PH2 ranging from 30 to 45 MPa
cleaning in alcohol showed no positive effect. Storage time of
compared to group PH1. However, after 150 days storage,
150 days with thermal cycling caused a statistically significant
there was no significant difference for bond strengths of
reduction in bond strength for all five test groups.
groups PH1 and PH2, showing mean values ranging from 12 to
Under the limitations of the study, the following conclu-
14 MPa.
sions are drawn:
In contrast to the current study, Szep et al. reported that the
use of glycerin as well as the use of fluid silicone led to a slight
but not a statistically significant decrease in bond strength, (1) Air-abrading the contaminated zirconia ceramic surface
when the silica ceramic specimens were acid etched with 9.5% led to significantly higher resin-ceramic bond strength val-
HF for 60 s. After 5000 thermal cycles the mean bond strengths ues than cleaning the contaminated zirconia ceramic sur-
ranged from 7.5 to 9.9 MPa. The relatively low bond strength face with phosphoric acid or alcohol.
values were explained by the choice of the composite resin (2) After the use of a silicone disclosing medium and saliva
material which was designed to be used with ultrasound acti- immersion, cleaning with alcohol or without any cleaning,
vation but was used without it in the experiment. only very low initial bond strength was achieved. There-
The resin bond strength values to zirconium oxide ceramic fore, cleaning of the contaminated ceramic surface before
presented in the literature vary between 3.4 and 61.0 MPa adhesive cementation is an indispensable step in order to
depending on the testing equipment, resin cements, ceramic achieve a durable bond.
512 d e n t a l m a t e r i a l s 2 3 ( 2 0 0 7 ) 506–512

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