RESIN BOND TO DENTAL CERAMICS, PART II: HIGH‐STRENGTH CERAMICS

Abstract

The popularity of high‐strength ceramic systems is increasing, and the range of their clinical indications is expanding constantly. Glass‐infiltrated aluminum oxide ceramic (eg, InCeram® Alumina, Vita Zahnfabrik, Bad Säckingen, Germany), densely sintered aluminum oxide ceramic (eg, Procera® AllCeram, Nobel Biocare AB, Gothenburg, Sweden), and zirconium oxide ceramic (eg, Procera AllZirkon®, Lava® 3M ESPE, St. Paul, MN, USA, Cercon®, Dentsply Ceramco, Burlington, NJ, USA) are popular oxide‐based high‐strength ceramic materials that offer favorable esthetic characteristics, mechanical properties, and biocompatibility. Proper selection and application of luting agents for final cementation of all‐ceramic restorations are keys for their clinical success. The few clinical trials on full‐coverage, high‐strength ceramic restorations report acceptable success rates with conventional luting agents. However, an article discussed in Part I of this Critical Appraisal reviewed available in vitro and in vivo studies on this topic and recommended adhesive cementation of ceramic and even high‐strength ceramic restorations. These findings contradict many manufacturers’claims and clinicians’preferences because resin bonding is a technique‐sensitive and time‐consuming procedure. However, resin bonding has a number of advantages (eg, increased retention, improved marginal adaptation, and higher fracture resistance of the restored tooth and the restoration itself) and is required for some minimally invasive treatment options, such as resin‐bonded fixed partial dentures and laminate veneers.The resin bond to silica‐based ceramics is well documented (as discussed in Part I of this Critical Appraisal) and yields predictable and long‐term durable results through adequate surface preparation. Part II focuses on in vitro studies of the bonding interface of some popular high‐strength ceramic materials. Comparative clinical trials are lacking, and the few available in vitro studies indicate that the composition and physical properties of oxide‐based high‐strength ceramics require surface preparation and bonding techniques that differ substantially from those used for silica‐based ceramics.