New approach to bonding all-ceramic adhesive fixed partial dentures:
A clinical report
Mutlu Özcan, Dr Med Dent,a and Akkan Akkaya, DDSb
Faculty of Dentistry, Marmara University, Istanbul, Turkey
This clinical report describes the use of intraoral silica coating and silanization in an alternative bond-
ing procedure for a 3-unit, all-ceramic, resin-bonded fixed partial denture. (J Prosthet Dent 2002;88:
252-4.)
A ll-ceramic restorations were introduced to improve
esthetics in restorative dentistry. They have been sug-
gested for use in 3-unit anterior fixed partial dentures
(FPDs) and in resin-bonded FPDs.1 Clinical application
of a resin-bonded FPD (RBFPD) requires a strong and a
stable resin bond to the ceramic.
Poorer success rates have been reported for all-ce-
ramic inlays and posterior crowns luted with glass iono-
mer than those luted with composite cement.2 Previous
investigations revealed that most clinical failures initi-
ated from the cementation surfaces of adhesive restora-
tions.3-5 Internal surfaces have been cited as the location
of highest tensile stresses and/or critical flaws; these
surfaces therefore need to be strengthened.
Etching the inner surface of a crown or an extracoro-
nal restoration with hydrofluoric acid followed by the
application of a silane is a well-known and recom-
mended method to increase bond strength.6-11 Hy-
drofluoric acid dissolves either the glassy or the crystal-
line components of the ceramic. According to some
authors, etching silica-based ceramics with hydrofluoric
acid, ammonium bifluoride, or acidulated phosphate
fluoride gel creates a sufficient resin bond that can be
enhanced with silane coating of the etched conventional
ceramics.7,12-14 Although hydrofluoric acid is efficient in
roughening feldspathic porcelain for bonding resin ce-
ment, the optimal concentration and duration of its ap-
plication are not well established. This fact is reflected in
the variety of concentrations of commercially available
hydrofluoric acids.
Moreover, no obvious correlation has been found
between bond strengths with resin cement and the mi-
croscopic characteristics of feldspathic porcelain after
etching.15 In 2 studies, neither etching with these solu-
tions nor adding silane resulted in an adequate resin
bond to all-ceramics.16,17 Hydrofluoric acid and acidu-
lated phosphate fluoride may facilitate micromechanical
retention, but these chemical agents have hazardous ef-
fects in vivo, including irritation of the soft tissues.18,19
Although the bond results obtained with hydrofluoric
a
Assistant Professor and Lecturer, Department of Prosthodontics.
b
PhD student, Department of Prosthodontics.
252 THE JOURNAL OF PROSTHETIC DENTISTRY
acid were found to be satisfactory in some studies,7,13
alternative conditioning techniques may be preferred.
Recent developments in modern surface condition-
ing methods have resulted in improved resin-to-ceramic
bond strengths.20 All of these new systems involve con-
ditioning the substrate to produce bifunctional mole-
cules that adhere to the surface through silane by means
of a polymerizable double bond.21,22 The manufacturers
of most new surface-conditioning systems require air-
borne particle abrasion of the surface before bonding to
achieve high bond strength. One such system is silica
coating. In this technique, an intraoral device is used to
air-abrade the surfaces with alumina modified with silisic
acid (CoJet-Sand; ESPE, Seefeld, Germany). The blast-
ing pressure embeds silica particles on the ceramic sur-
face, rendering the surface chemically more reactive to
the resin.
The shear bond strengths between resin cement and
all-ceramics treated with silica coating were reported to
be significantly higher than those obtained when hy-
drofluoric acid and aluminum oxide were used.17,22,23
Silica coating systems have been described for intraoral
ceramic repair,24 but other clinical uses have not been
reported. This clinical report describes the use of in-
traoral silica coating and silanization in an alternative
bonding procedure for a 3-unit, all-ceramic RBFPD.
CLINICAL REPORT
A 32-year-old man who had lost his maxillary left
lateral incisor after a car accident 4 months previously
was referred from a private practice to the Department
of Prosthetic Dentistry at the University of Marmara
(Istanbul, Turkey). The patient’s chief complaint was his
unesthetic appearance. A 3-unit, all-ceramic RBFPD
was selected as the treatment of choice for conservative
and esthetic reasons. Before preparations began, radio-
graphic evaluations were conducted to ensure that the
designated abutments had adequate periodontal health
and root support. After the tooth preparations were
complete (Fig. 1, A), an all-ceramic RBFPD was fabri-
cated (Fig. 1, B). A satisfactory appearance was obtained
after cementation (Fig. 1, C). The restoration has been
in place for 1 year.
VOLUME 88 NUMBER 3
ÖZCAN AND AKKAYA
Fig. 1. A, Palatal view of tooth preparation on maxillary left
central and lateral incisors for adhesive RBFPD. B, Inner
surface of IPS Empress II adhesive RBFPD after silica coating.
C, Labial view of satisfactory esthetic result after 3 months.
The following clinical sequence was applied to bond
the RBFPD with intraoral silica coating and silanization:
After determining the appropriate color for the luting
cement, the prepared teeth were isolated with a rubber
dam. Etching and bonding agents were applied in accor-
dance with the manufacturer’s recommendations (Vari-
olink II; Vivadent, Schaan, Liechtenstein). Protective
eyeglasses and masks were supplied for both the patient
and staff. Strong evacuation for CoJet-Sand and saliva
was required. The inner surface of the restoration was
air-abraded with an intraoral device (Dento-Prep; Røn-
SEPTEMBER 2002
THE JOURNAL OF PROSTHETIC DENTISTRY
vig, Daugaard, Denmark). Air particle abrasion was used
with a nozzle distance of approximately 10 mm from the
surface at an angle of 90 degrees for 13 seconds at 2.3
psi. The conditioned surfaces were silanized with ESPE-
Sil (ESPE) and allowed to dry for 5 minutes. No air-
drying was used because of possible water or oil contam-
ination.
The dentin and enamel were total etched with 37%
phosphoric acid (Email Preparator; Vivadent) for 20
seconds. The dentin was conditioned (Syntac Adhesive
and Primer and Heliobond; Vivadent), and an IPS Em-
press II (Ivoclar, Schaan, Liechtenstein) all-ceramic
RBFPD was luted with a dual-polymerizing composite
(Variolink II; Vivadent) in accordance with the manu-
facturer’s instructions. The luting agent was applied to
the preparation and internal surface of the restoration
with a disposable brush. The restoration was inserted
with moderate pressure, and excess luting agent was
carefully removed with an explorer. Under slight pres-
sure, the restoration was light-polymerized from 3 dif-
ferent directions for 40 seconds (Translux; Kulzer, Dor-
magen, Germany). The intensity of the light-
polymerizing unit (Model 8000; Cure Rite,
Williamsville, N.Y.) was 480 mW/cm2.
After polymerization was completed, excess cement
was removed from the margins with a periodontal scaler
(HyLite, Hamburg, N.Y.). After the rubber dam was
removed, the occlusion was carefully evaluated, and ad-
justments were made on the restoration with an intraoral
porcelain finishing set (Edenta Porcelain Veneer Kit;
Edenta AG Dental Produkte, Lugano, Switzerland).
SUMMARY
The use of silica coating and silanization in an alter-
native bonding procedure for a 3-unit, all-ceramic, res-
in-bonded fixed partial denture has been described.
Practitioners should consider the use of this technique
for the bonding of adhesive restorations.
We thank ESPE (Seefeld, Germany) for its generous donation of
the testing materials.
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