Page 65 - SURE DENTAL CATALOGUE 2023

Treatment Of And Delivery Of An All- Dr.John Kanca

Ceramic Restoration

By: John Kanca, III, DMD
2009-03-01

Ceramic prosthetics can provide patients with durable, functional and esthetic
restorations. While all phases related to this process are important, this article will focus
on the proper delivery of a ceramic restoration. Proper delivery will mean utilization of
the right materials and the proper technique. Among the materials necessary is a dentin-enamel bonding
system, a ceramic primer and a luting resin. There are varying opinions as to the treatment of the ceramic
itself. Considerations in the treatment of porcelain surfaces include surface roughening of the porcelain, the
use of hydrofluoric acid and the use of silane.

Surface roughening
It has shown that surface roughening will improve bond strengths to porcelain. The roughening may be
accomplished via air-driven particulates (i. e. sandblasting) or by the use of hydrofluoric acid. The use of
sandblasting alone has been shown to improve bond strengths to porcelain, although it is most frequently
used in conjunction with hydrofluoric acid. 1-3 Ironically, while surface roughening improves bond strength of
resin to porcelain, roughening, including sandblasting, has also been shown to decrease the fleural strength
of porcelain. 4-8 The use of a resin following defect introduction is shown to improve flexural strengths. 9-10

Hydrofluoric acid
Horn11 first suggested the use of ceramic etching to aid retention and it was further explored by Simonsen
and Calamia. 12 They used 7.5% hydrofluoric acid to create a micro-porous porcelain surface to aid
retention. Later, Stangel, Nathanson and Hsu used both 20% and 52% hydrofluoric acid to etch porcelain.
13 Currently there is no one recommended approach to porcelain treatment, although some are similar to
one another. Chen at al reported that the use of 5% HF for 120 seconds yielded the highest bond strengths.
14 Güler et al suggested 9.6% for 120 seconds. 15 Nagayassu et al recommended 10% HF for 120
seconds. 16 Boscato, Della Bona and Del Bel Curry found 9.5% HF for 120 to yield the highest bond
strengths, 17 while Peumans et al found 4.9% HF for 60 seconds to be effective. 18

Silane

Silane has long been recommended for the treatment of porcelain surfaces.19-21 Although there is
sometimes a debate as to its necessity, many researchers feel that not only is it important, it is the most
important element in porcelain bonding. 14,22,23 Barghi asserted that silane provides a bond more
reliable than with HF alone. 24 Silane also is reported to improve the long term stability of resin bond to
porcelain. 25
A ceramic onlay is treatment planned for the mandibular first molar seen in Figure 1. A facial view shows
staining under an old resin composite restoration (Fig. 2). The preparation for the onlay is seen in Figure
3. A temporary onlay is formed (Fig. 4) and the preparation is sealed with a no-rinse dentin-enamel resin
adhesive (Surpass®, Apex Dental Materials, Sure Dental Innovations, Oakville, Ontario, CA). Surpass® is
a three bottle self-etching bonding system capable of affixing any type of resin composite -- light-cure,
dual-cure and self-cure resin composites. It can be made exquisitely thin and can be utilized for both
direct and indirect procedures. Surpass TM has been tested at Tufts, the University of North Carolina and
at an independent, non-profit dental education and product testing foundation, generating over 50 MPa of
bond strength at each venue within two hours (notched shear test method). As it has a separate
conditioner, primer and bonding resin, it is similar to 4th generation systems. It performs as well as any 4th
generation system yet is easier to use.
Delivery of a ceramic restoration can be described as having three components; treatment of the tooth,
treatment of the prosthesis, and the cement to join the two.

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