Lasers Med Sci (2013) 28:259–266
DOI 10.1007/s10103-012-1136-x
ORIGINAL ARTICLE
Bond strength of resin cement to zirconia ceramic
with different surface treatments
Aslıhan Usumez & Nermin Hamdemirci &
Bilge Yuksel Koroglu & Irfan Simsek & Ozge Parlar &
Tugrul Sari
Received: 7 March 2012 / Accepted: 31 May 2012 / Published online: 21 June 2012
# Springer-Verlag London Ltd 2012
Abstract Zirconia-based ceramics offer strong restorations
in dentistry, but the adhesive bond strength of resin cements
to such ceramics is not optimal. This study evaluated the
influence of surface treatments on the bond strength of resin
cement to yttrium-stabilized tetragonal zirconia (Y-TZP)
ceramic. Seventy-five plates of Y-TZP ceramic were ran-
domly assigned to five groups (n015) according to the
surface treatments [airborne particle abrasion, neodymium-
doped yttrium aluminum garnet (Nd:YAG) laser irradiation
(Fidelis Plus 3, Fotona; 2 W, 200 mJ, 10 Hz, with two
different pulse durations 180 or 320 μs), glaze applied,
and then 9.5 % hydrofluoric acid gel conditioned, control].
One specimen from each group was randomly selected, and
specimens were evaluated with x-ray diffraction and SEM
analysis. The resin cement (Clearfil Esthetic Cement, Kur-
aray) was adhered onto the zirconia surfaces with its
corresponding adhesive components. Shear bond strength
of each sample was measured using a universal testing
machine at a crosshead speed of 1 mm/min. Bond strengths
were analyzed through one-way ANOVA/Tukey tests. Sur-
face treatments significantly modified the topography of the
Y-TZP ceramic. The Nd:YAG laser-irradiated specimens
resulted in both increased surface roughness and bond
strength of the resin cement. The highest surface roughness
and bond strength values were achieved with short pulse
A. Usumez : T. Sari (*)
Faculty of Dentistry, Department of Prosthodontics,
Bezmialem Vakıf University,
Adnan Menderes Bulvarı Vatan Caddesi,
34093 Fatih Istanbul, Turkey
e-mail: tugrulsari@hotmail.com
N. Hamdemirci : B. Y. Koroglu : I. Simsek : O. Parlar
Faculty of Dentistry, Department of Prosthodontics,
Gaziantep University,
Gaziantep, Turkey
duration. Nd:YAG laser irradiation increased both surface
roughness of Y-TZP surfaces and bond strength of resin
cement to the zirconia surface.
Keywords Nd:YAG laser . Zirconia . Shear bond strength .
Surface roughness . XRD analysis . Surface treatment
Introduction
In the last decade, zirconium oxide ceramics (zirconia) have
become more popular and convenient, and the use of this
material increases over time, following the advances in
CAD-CAM technology. Zirconia offers a wide variety of
clinical applications, such as orthodontic brackets, postcore
restorations, implant abutments, and fixed partial dentures
[1]. This is a high-strength, silica, and glass-free ceramic
material which is highly composed of yttrium-stabilized
tetragonal zirconia polycrystals (Y-TZP), and the material
exhibits a unique behavior under stress, called as “stress-
induced transformation toughening.” Zirconia polycrystals
can resist crack propagation by transforming from a tetrag-
onal to a monoclinic phase at the tip of the crack, which is
associated with a volume increase [2]. The combination of
these superior biomechanical and optical properties and
biocompatibility offers the material as an alternative for
metals used in prosthodontic applications [3]. On the other
hand, the long term success of the restoration is also depen-
dent to the success of cementation procedure, and because
of the lack of silica and glass phase, conventional adhesive
conditioning methods, such as acid etching and silanation,
are not efficient for zirconia ceramics [4]. This problem is
the primary limitation regarding the use of zirconia ceramic
in dental restorations, and many researchers have investi-
gated this challenging issue.
260
In recent years, research has focused on developing dif-
ferent adhesive strategies to achieve surface roughening and
chemical bonding of zirconia. Airborne-particle abrasion
(APA) alone slightly roughens the zirconia surface [5], but
this roughness is not enough to provide reliable resin bond
strength [4]. Furthermore, combining this procedure with
silane coupling agent is also seems to be useless [4]. How-
ever, tribochemical silica coating of zirconia ceramics is
reported as an effective method to increase the bond strength
of adhesive cements to zirconia ceramics [6]. Another rec-
ommended procedure is to associate APA (Al2O3 or silica
coating) and luting agents containing phosphate ester mono-
mer 10-methacryloxydecyl dihydrogen phosphate (MDP)
[1]. Moreover, Cura et al. [7] anticipated that a thin
glaze layer that adheres well to zirconia [8] could de-
liver durable adhesion similar to glass ceramics when it
is etched with hydrofluoric (HF) acid, and they con-
cluded that this procedure improved the bond strength
of adhesive resin to zirconia surface. In spite of these
advances, it is well known that chemical bonding is
susceptible to hydrolytic degradation [4]. For this rea-
son, in addition to these improvements in chemical
bonding techniques, the endeavor in forming surface
roughness to achieve micromechanical retention still
continues. An innovative approach was first developed
by Sadoun and Asmussen [9] who sintered fine-grained
refractory powder at the intaglio surface of alumina-
based ceramic to create a positive retention. There are
some recent studies focusing on forming retention on
zirconia surface using the same principle [10, 11]. An
additional innovative treatment for the development of
surface roughness is the use of laser etching.
Solid- or gas-state lasers have become increasingly pop-
ular in dentistry. Neodymium-doped yttrium aluminum gar-
net (Nd:YAG) lasers have indications for hypersensitivity of
tooth [12], caries removal [13], sealing of pits and fissures
[14], tooth bleaching [15], and disinfection of tissues [16].
In addition, it was found that the use of Nd:YAG laser on
feldspathic porcelain prior to adhesive cementation has
resulted improved bond strength values comparable with
hydrofluoric acid etching [17]. Also, there are some studies
reporting that the Nd:YAG laser-treated surfaces of alumina-
based ceramics showed a micromechanical retention pattern
which is more favorable for resin bonding [18, 19]. How-
ever, there are little data regarding the effect of Nd:YAG
laser on Y-TZP ceramics.
The aim of this study was to evaluate the effect of various
chairside treatments, such as Nd:YAG lasers, Al2O3 APA,
and glaze application followed by 9.5 % HF acid gel, on
zirconia-to-resin shear bond strength (SBS). The hypothesis
tested was that Nd:YAG laser, as well as APA and glaze +
HF acid gel application of zirconia, would not influence the
SBS of Y-TZP to resin cement.
Lasers Med Sci (2013) 28:259–266
Materials and methods
Seventy-five zirconium oxide core specimens (7.5 mm in
length and 5 mm in width) were produced with a copy-
milling machine (Zirconzahn, Bruneck, Italy) and CNC
software using prefabricated blanks of zirconium oxide
(Ice Zircon Translucent; Zirconzahn) and then sintered
according to manufacturer's instructions. Zirconium oxide
cores were embedded in the centers of autopolymerizing
acrylic resin blocks.
Zirconium oxide core surfaces were ground finished with
240–400–600 grit silicon carbide abrasive papers (3 M
ESPE, St. Paul, MN, USA) for 15 s using a 170-rev/min
grinding machine (Minitech 233; Presi, Grenoble, France)
under running water, ultrasonically cleaned for 3 min in
ethanol and deionized water, and air dried. Subsequently,
all specimens were distributed into five groups each and
composed of 15 specimens.
Zirconia core surface treatment
Group A
Feldspathic glazing ceramic powder mixed with stain liquid
(Finesse stain liquid, powder; Ceramco II, Dentsply, York,
PA, USA) was applied as a thin coat using a ceramic brush.
The specimens were then placed in a porcelain furnace
(Programat 300, Ivoclar Vivadent, Schaan, Liechtenstein).
The heat treatment program started at 400 °C with 6 min
preheating. Then the temperature was raised by 55 °C/min
under vacuum. Specimens were kept at the final temperature
of 820 °C for 1 min before cooling started. Then the speci-
mens were conditioned with 9.5 % HF acid gel (Ultradent,
South Jordan, UT, USA) for 60 s and rinsed with water for
90 s. They were then neutralized with the diluted solution by
neutralizing powder, washed thoroughly with water for 20 s,
and dried.
Group B
Alumina sandblasting was performed using 110 μm grain-
sized aluminum oxide sand (Alodur ZWSK, Treibacher
Schleifmittel, Villach, Austria) for 15 s at 2.8-bar pressure
(Silver Dental Farm, Torino, Italy). Distance of the tip from
the ceramic surface was about 10 mm.
Group D
The surfaces were coated with graphite prior to laser irradi-
ation to increase energy absorption. Nd:YAG laser (λ0
1,064 nm; Fidelis Plus III, Fotona; Ljubljana, Slovenia)
was delivered using 300-μm-diameter optical fiber perpen-
dicular to the surface, scanning the ceramic surface during
Lasers Med Sci (2013) 28:259–266
60 s. The output settings were 200 mJ/pulse, and the pulse
repetition rate was 10 Hz. The pulse duration was 180 μs.
No air or water cooling was used during laser irradiation.
Group E
The surfaces were coated with graphite prior to laser irradi-
ation to increase energy absorption. The Nd:YAG laser
irradiation was applied to surface with the same parameters
as described above, but the pulse duration was 320 μs. No
air or water cooling was used during laser irradiation.
Group C
Group C served as a control, and no surface treatment was
applied. Different surface treatments of the groups were
summarized at Table 1.
Surface roughness analysis
Surface roughness (Ra in micrometer) measurements were
performed on each disc using a surface profilometer (Perth-
ometer, Mahr, Gottingen, Germany) with a cutoff value of
1 mm and measuring length of 5 mm. The Ra value
describes the average roughness value for a surface that
has been traced by the profilometer. A lower Ra value
indicates a smoother surface. Three tracings at different
locations on each specimen were obtained, and a mean value
was calculated.
Scanning electron microscopy examination
In order to perform a qualitative micromorphologic exami-
nation of ceramic surfaces, one additional specimen from
each group was sputter coated with gold and analyzed using
a SEM (JSM-5310; JEOL, Peabody, MA, USA) at 20 kV.
Table 1 Different surface treatments of the groups
Groups Surface treatment
Group Ground finished with abrasive paper, ultrasonically cleaned,
A glazed, conditioned with HF acid gel 9.5 % for 60 s, and
rinsed with water for 90 s
Group Ground finished with abrasive paper, ultrasonically cleaned,
B and sandblasted with 110 μm of aluminium oxide for 15 s
at 2.8-bar pressure
Group Ground finished with abrasive paper and ultrasonically
C cleaned; served as the control group
Group Ground finished with abrasive paper, ultrasonically cleaned,
D coated with graphite, treated with 200 mJ/pulse and 10 Hz
Nd:YAG laser for 60 s; pulse duration was 180 μs
Group Ground finished with abrasive paper, ultrasonically cleaned,
E coated with graphite, treated with 200 mJ/pulse and 10 Hz
Nd:YAG laser for 60 s; pulse duration was 320 μs
261
Photomicrographs of representative areas for the surface treat-
ments applied on ceramic groups were obtained at 500 and
1,000× magnifications.
X-ray diffraction analysis
One specimen from each group was randomly selected and
examined in order to determine the effects of various surface
treatments on the monoclinic phase transformation of zirco-
nia. The relative amount of the monoclinic phase was deter-
mined with an X-ray diffractometer (Rigaku D/Max-2200/
PC; Rigaku Corp., Tokyo, Japan), equipped with Cu-Kα
radiation. X-ray diffraction (XRD) spectra were collected at
40 kV (20 mA) over a 2θ range between 24 and 40 ° at a
scan speed of 2 °/min. The monoclinic phase fraction was
calculated by the Garvie–Nicholson method [20].
Resin cement fabrication
A fluid path (Mediflex, Eczacıbaşı, Istanbul) with a hole in
the center (3 mm in diameter and 2 mm in height) was
prepared for each specimen. The surface of each specimen
was then cleaned with 40 % phosphoric acid (K-Etchant
Gel; Kuraray Co. Ltd., Osaka, Japan) for 5 s and rinsed with
water for 15 s, and the specimens were immersed in an
ultrasonic bath for 2 min. Following air drying, a MDP-
containing primer (Clearfil Ceramic Primer; Kuraray Co.
Ltd.) was applied to the surface and left to dry for 5 min.
Equal amounts of luting cement (Clearfil Esthetic Cement;
Kuraray Co. Ltd.) A and B pastes were mixed for 20 s and
inserted in the plastic mold without bubble. The resin cyl-
inder was light polymerized for 20 s at 800 mW/cm2 (Led-
max 5, Benlioglu Dental, Istanbul). The cement surface was
protected with an oxygen barrier (Oxiguard II; Kuraray Co.
Ltd.) for 3 min according to manufacturer's instructions.
One resin cement cylinder was built onto each ceramic
block, resulting in 15 specimens per subgroup.
Shear bond strength test
Specimens were perpendicularly engaged at their bases with
a custom probe in a universal testing machine (Shimadzu
AG-X, Tokyo, Japan) at a crosshead speed of 1 mm/min
until bonding failure occurred. To convert the load values
(kilogram) to megapascals (MPa), failure load was con-
verted to Newtons (N) and was divided by the bonding area
(square millimeter). The fractured surface was assessed by
examination of the debonded surfaces with a stereomicro-
scope (M165C; Leica Microsystems, Wetzlar, Germany) at
22× magnification and was classified according to one of
three types: (1) adhesive failure, resin cement was less than
20 % on zirconia core; (2) cohesive failure resin cement was
262 Lasers Med Sci (2013) 28:259–266

more than 80 % on zirconia core, and (3) mixed failure resin
cement was between 20 and 80 % on zirconia core.
Statistical analysis
The ultimate stress (MPa) of the zirconia–resin cement was
calculated as follows:
Failure load ðNÞ
Stress ¼
Surface area ðpi  r2 Þ ðmm2 Þ
The SBS values were analyzed with statistical software
(Statistical Package for the Social Sciences (SPSS) PC, ver-
sion 10.0; SPSS, Chicago, IL). One-way analysis of variance
was used to analyze the data for significant differences. Tukey
HSD tests were used to perform multiple comparisons among
the groups at a significance level set at p<0.05.
SEM analysis
In the SEM micrographs, the surface of the control group
was nearly smooth except some scratch-like traces and
shallow pits made by abrasive polishing papers. After
APA, the surface appeared coarsened, with a uniform pres-
ence of irregularities and deeper pits than the control group
were observed. Glazing the surface caused smoothness, and
etching the glaze layer with HF acid has generated many
crater-like individual cavities on the surface with various
depths; collapsed glaze material has also been observed at
the base of these craters. In the micrographs of Nd:YAG
laser-irradiated groups, the most remarkable surface forma-
tion was the presence of microcracks all over the surface
like a network (Fig. 1).
Shear bond strength test

Nd:YAG laser-irradiated specimens resulted in increased

Results bond strength for resin cement. The highest bond strength
values were achieved with short pulse duration (group D)
Surface treatments have modified the topography of the Y- (8.17 MPa), followed by long pulse duration (group E)
TZP ceramic, and significant differences were identified (6.99 MPa). Differences between the bond strength results
among the surface roughness values and SBS test results of these two groups were not significant. However, SBS
of the groups. values of the other three groups were comparable to each
other and significantly lower than the laser-etched groups
Surface roughness (Table 2). As a result of stereomicroscopic observation, all
failures were scored as adhesive failure (score 1), except that
The control group (group C) had the lowest surface rough- only two specimens with mix failure (score 3) were one
ness values (0.16). Roughness values of groups A (0.67) and specimen each from groups A and C.
B (0.19) were comparable with the control group. The
differences between the surface roughness values of the XRD analysis
Nd:YAG laser-etched groups (groups D and E) and the
groups mentioned above were significant. In addition, sur- The relative amounts of monoclinic (m) zirconia, which was
face roughness values of group D (6.39) were significantly detected with XRD on treated surfaces of the specimens,
higher than group E (3.41) (Table 2). were varied between 13 and 30.5 %. The control group,
which was simply polished (group C), had the lowest mono-
Table 2 Surface roughness of zirconia surface, shear bond strength clinic content (13 %). Glazing and acid etching (group A)
values of resin cement to zirconia surface (mean ± standard deviations) caused a slight increase of the monoclinic content of zirco-
and monoclinic zirconia content rates of the groups
nia (15.7 %), and the result of the APA group (group B) was
Groups Number Surface SBS Monoclinic 16.2 %. On the other hand, monoclinic content of zirconia
roughness (MPa) content after laser irradiation with long pulse duration was 26.5 %
(μm) (%)
(group E), and with short pulse duration, group D (30.5 %)
Group A 15 0.67±0.16a 4.99±1.7A 15.7 (Table 2, Fig. 2).
(Glaze + HF)
Group C (control) 15 0.16±0.09a 3.73±1.9A 13
Group B (APA) 15 0.19±0.1a 4.26±1.7A 16.2 Discussion
Group E 15 3.41±0.8b 6.99±1.6B 26.5
(Nd:YAG, LP) This study evaluated the effect of various surface treatments
Group D 15 6.39±1.08c 8.17±1.9B 30.5
(Nd:YAG, SP)
on the surface roughness and SBS of a zirconia ceramic to a
resin cement. There were significant differences among the
Groups with different letters are statistically significantly different experimental groups. The null hypothesis that various sur-
LP long pulse (320 μs), SP short pulse (180 μs) face treatment procedures on zirconia ceramic surface
Lasers Med Sci (2013) 28:259–266
Fig. 1 SEM micrographs of
zirconia surface: (a) control
group, (b) glazed surface, (c)
glaze + HF acid etching, (d)
airborne particle abrasion, (e)
Nd:YAG laser treatment with
short pulse, and (f) Nd:YAG
laser treatment with long pulse
would not influence the SBS of resin cement to zirconia
ceramic is rejected.
Previous studies have reported a limitation for shear
bond testing method related to the possibility of cohe-
sive failures that may occur within the base material,
such as porcelain or within the resin cement [21–23].
Such kind of cohesive failures may lead to misinterpre-
tation of real bond strength results. In the current study,
almost all specimens (73 of 75) were failed adhesively,
so it should be considered that the different results among the
experimental groups was originated from the differences of
adhesive interface of ceramic material that is treated with
various procedures.
Chemical bonding is one of the key factors for the suc-
cess of adhesion. For Y-TZP ceramics, it was shown that
conventional silane coupling agents do not have potential
for chemical bonding to the material [4] and a phosphate
containing hydrotically stable monomer, called as MDP,
263
improves the adhesion between the resin cement and zirco-
nia ceramic [1, 23, 24]. In the current study, a ceramic
primer, which is containing both MDP and 3-(trimethoxy-
silyl)propyl methacrylate (TMSPMA), is used, and this
primer is presented by the manufacturer as useful for bond-
ing of resin cement to all types of dental ceramics.
As mentioned before, the strength and toughness of zir-
conia result from a characteristic process due to transforma-
tion from the tetragonal to the monoclinic phase. This
transformation is associated with a volume increase of about
4 %, and expansion of the zirconia crystals induces local
compressive stresses around the tip of the crack. By this
way, zirconia polycrystals can resist crack propagation [25].
However, unfortunately, the phase transformation conse-
quently spreads gradually along the surface and penetrates
into the depth of the material [26], and it is reported that a
high level of monoclinic phase may be detrimental to me-
chanical characteristics, such as strength and toughness, and
264
Fig. 2 XRD analysis graphics
of the specimens: (a) control
group, (b) glaze + HF acid
etching, (c) airborne particle
abrasion, (d) Nd:YAG laser
treatment with short pulse, (e)
Nd:YAG laser treatment with
long pulse, and (f) combined
graphic of all groups
may impair the long-term clinical success of zirconia-based
restorations [27].
Surface roughness is considered as another important
factor for adhesion that increases the surface area, improves
the wettability by reducing the surface tension, and creates
micromechanical retention. APA is one of the common
methods used to increase the surface roughness. Some
investigators suggested that superior bonding to zirconia is
obtained when surfaces are air abraded [1, 28]. However,
others concluded that this method does not have a signifi-
cant effect to improve the bonding of resin cement to zirco-
nia ceramic [6, 23, 24, 29]. In addition, the risk of microcrack
generation with the use of airborne APA method was also
reported [30, 31]. In the current study, air particle abrasion did
not increase the surface roughness and SBS when compared to
the control group. There was slight difference on the surface in
SEM micrographs, and this was confirmed by the surface
roughness measurements, but these differences were not sig-
nificant. There was not any crack formation detected on the
particle-abraded zirconia surface, and XRD analysis results
showed a slight increase at monoclinic zirconia content of the
surface.
Cura et al. [7] reported that HF acid etching of zirconia
surface following glaze application significantly increases
the SBS of resin cement to the ceramic, when the conven-
tional silane coupling agents are combined with the cement.
However, if MDP containing zirconia primer is used instead
of silane agent, glaze + HF acid etching was not significant-
ly effective. They specified that MDP containing zirconia
Lasers Med Sci (2013) 28:259–266
primer is useless when the zirconia surface was covered
with the glaze porcelain that has a glassy matrix. Although
the primer used in this study is presented to be used with all
types of ceramics, HF acid etching following glaze applica-
tion did not cause any significant difference as well as APA.
In addition, the monoclinic phase content percentage of
zirconia surface was slightly increased after the glaze +
HF acid etching procedure that is comparable to the control
and APA groups.
In the current study, it was seen that surface roughness
and SBS results of Nd:YAG laser-treated groups were sig-
nificantly higher than the three groups mentioned before.
While Paranhos et al. [3] have reported similar results to the
current study, Akyıl et al. [32] have reported that Nd:YAG
laser treatment improves the SBS of resin cement only with
the combination of APA. In contrast to our study, they
suggested that when the Nd:YAG laser treatment was used
without particle abrasion, SBS of the resin cement
decreases. In addition, as a result of current study, it was
seen that altering the pulse duration caused a significant
difference between the surface roughness values of laser-
treated groups. Because of the shorter pulse duration, the
peak power of the laser beam was increased from 625 to
1,110 W, and this alteration enhanced the surface roughness
of the specimens of short pulse duration group when com-
pared to the long pulse duration group. In spite of this
difference, SBS results of laser-treated groups were compa-
rable to each other. The interactions and possible favorable
and unfavorable effects of lasers with shorter pulse durations
Lasers Med Sci (2013) 28:259–266
(nanosecond, picosecond, etc.) should be considered as a new
investigation area for further researches.
Although in these significant improvements, Nd:YAG
laser application also created destructive alterations on the
surface of zirconia ceramic. In the SEM micrographs,
microcracks, which are connected to each other, were obvi-
ously detectable. There are some studies in the literature
reporting the observation of microcracks on the zirconia
surface after Nd:YAG treatment [3, 32]. The authors related
these microcracks to the stress generation due to uncon-
trolled temperature changes at the zirconia surface during
laser treatment. It can be predicted that these network-like
microcracks on the surface may weaken the material and
cause catastrophic failures in long term. In addition, it was
determined that Nd:YAG laser treatment also induced te-
tragonal to monoclinic phase transformation of zirconia. A
remarkably high amount of monoclinic zirconia was deter-
mined at the laser-treated zirconia surface as a result of XRD
analysis when compared to the other groups. The effects of
such high amount of monoclinic zirconia on mechanical
characteristics of material must be questioned with further
studies.
Conclusions
Nd:YAG laser irradiation with both short and long pulse
durations significantly increased surface roughness of Y-
TZP surfaces, while the results of short pulse laser irradia-
tion was better. The shear bond strength of the resin cement
to the zirconia surface in the laser groups was comparable to
each other and was significantly higher than the results of
other groups. On the other hand, in this study, etching the
zirconia surface with Nd:YAG laser irradiation caused
microcracks and remarkably high monoclinic content of
zirconia, which, unfortunately, might reduce the resistance
and longevity of the material.
References
1. Wolfart M, Lehmann F, Wolfart S, Kern M (2007) Durability of the
resin bond strength to zirconia ceramic after using different surface
conditioning methods. Dent Mater 23(1):45–50
2. Denry I, Kelly JR (2008) State of the art of zirconia for dental
applications. Dent Mater 24:299–307
3. Paranhos MP, Burnett LH Jr, Magne P (2011) Effect of Nd:YAG
laser and CO2 laser treatment on the resin bond strength to zirconia
ceramic. Quintessence Int 42:79–89
4. Luthy H, Loeffel O, Hammerle CH (2006) Effect of thermocycling
on bond strength of luting cements to zirconia ceramic. Dent Mater
22(2):195–200
5. Borges GA, Spohr AM, de Goes MF, Sobrinho LC, Chan DC
(2003) Effect of etching and airborne particle abrasion on the
microstructure of different dental ceramics. J Prosthet Dent
89:479–488
265
6. Atsu SS, Kilicarslan MA, Kucukesmen HC, Aka PS (2006) Effect
of zirconium-oxide ceramic surface treatments on the bond
strength to adhesive resin. J Prosthet Dent 95:430–434
7. Cura C, Ozcan M, Saracoglu A (2011) Comparison of alternative
adhesive cementation concepts for zirconia ceramics: glaze layer
vs. zirconia primer. J Adhes Dent. doi:10.3290/j.jad.a21493
8. Magne P, Paranhos MP, Burnett LH Jr (2010) New zirconia primer
improves bond strength of resin based cements. Dent Mater 26
(4):345–352
9. Sadoun M, Asmussen E (1994) Bonding of resin cements to an
aluminous ceramic: a new surface treatment. Dent Mater 10:185–
189
10. Aboushelib MN, Kleverlaan CJ, Feilzer AJ (2007) Selective
infiltration-etching technique for a strong and durable bond of
resin cements to zirconia-based materials. J Prosthet Dent
98:379–388
11. Phark JH, Duarte S Jr, Blatz M, Sadan A (2009) An in vitro
evaluation of the long-term resin bond to a new densely sintered
high-purity zirconium-oxide ceramic surface. J Prosthet Dent
101:29–38
12. Birang R, Poursamimi J, Gutknecht N, Lampert F, Mir M (2007)
Comparative evaluation of the effects of Nd:YAG and Er:YAG
laser in dentin hypersensitivity treatment. Lasers Med Sci 22:21–
24
13. Harris DM, White JM, Goodis H et al (2002) Selective ablation of
surface enamel caries with a pulsed Nd:YAG dental laser. Lasers
Surg Med 30:342–350
14. Bahar A, Tagomori S (1994) The effect of normal pulsed Nd:YAG
laser irradiation on pits and fissures in human teeth. Caries Res
28:460–467
15. Marcondes M, Paranhos MP, Spohr AM et al (2009) The influence
of the Nd:YAG laser bleaching on physical and mechanical prop-
erties of the dental enamel. J Biomed Mater Res B Appl Biomater
90:388–395
16. Wang QQ, Zhang CF, Yin XZ (2007) Evaluation of the bactericidal
effect of Er, Cr:YSGG and Nd:YAG lasers in experimentally
infected root canals. J Endod 33:830–832
17. Li R, Ren Y, Han G (2000) Effects of Nd:YAG laser irradiation on
shear bond strength of composite resin bonded to porcelain. Hua
Kou Qiang yi Xue Za Zhi 18:377–379
18. da Silveira BL, Paglia A, Burnett LH, Shinkai RS, Eduardo C de P,
Spohr AM (2005) Micro-tensile bond strength between a resin
cement and an aluminous ceramic treated with Nd:YAG laser,
Rocatec system, or aluminum oxide sandblasting. Photomed Laser
Surg 23:543–548
19. Spohr AM, Borges GA, Júnior LH, Mota EG, Oshima HM
(2008) Surface modification of In-Ceram Zirconia ceramic by
Nd:YAG laser, Rocatec system, or aluminum oxide sandblast-
ing and its bond strength to a resin cement. Photomed Laser
Surg 26:203–208
20. Garvie RC, Nicholson PS (1972) Phase analysis in zirconia sys-
tems. J Am Ceram Soc 55:303–305
21. Palacios RP, Johnson GH, Phillips KM, Raigrodski AJ (2006)
Retention of zirconium oxide ceramic crowns with three types of
cement. J Prosthet Dent 96:104–114
22. Versluis A, Tantbirojn D, Douglas WH (1997) Why do shear bond
tests pull out dentin? J Dent Res 76:1298–1307
23. Kern M, Wegner SM (1998) Bonding to zirconia ceramic: adhe-
sion methods and their durability. Dent Mater 14:64–71
24. Wegner SM, Kern M (2000) Long-term resin bond strength to
zirconia ceramic. J Adhes Dent 2:139–147
25. Hannink RHJ, Kelly PM, Muddle BC (2000) Transformation
toughening in zirconia containing ceramics. J Am Ceram Soc
83:461–487
26. Chevalier J, Grandjean S, Kuntz M, Pezzotti G (2009) On the
kinetics and impact of tetragonal to monoclinic transformation in
266
an alumina/zirconia composite for arthroplasty applications. Bio-
materials 30:5279–5282
27. Kohorst P, Borchers L, Strempel J et al (2012) Low temperature
degradation of different zirconia ceramics for dental applications.
Acta Biomater 8(3):1213–1220
28. Ozcan M, Kerkdijk VLF (2007) Comparison of resin cement
adhesion to Y-TZP ceramic following manufacturers' instructions
of the cements only. Clin Oral Investig 13(3):279–282
29. Derand P, Derand T (2000) Bond strength of luting cements to
zirconium oxide ceramics. Int J Prosthodont 13:131–135
Lasers Med Sci (2013) 28:259–266
30. Kosmac T, Oblak C, Jevnikar P, Funduk N, Marion L (1999) The
effect of surface grinding and sandblasting on flexural strength and
reliability of Y-TZP zirconia ceramic. Dent Mater 15:426–433
31. Kosmac T, Oblak C, Jevnikar P, Funduk N, Marion L (2000)
Strength and reliability of surface treated Y-TZP dental ceramics.
J Biomed Mater Res B Appl Biomater 53:304–313
32. Akyıl MS, Uzun IH, Bayındır F (2010) Bond strength of resin
cement to yttrium-stabilized tetragonal zirconia ceramic treated
with air abrasion, silica coating, and laser irradiation. Photomed
Laser Surg 28(6):801–808