The authors emphasize the need for both micromechanical retention and chemical adhesion to enhance longevity, marginal seal, and resistance to fracture.
Key Guidelines Based on Ceramic Type
1. Silica-Based Ceramics
(e.g., Feldspathic, Leucite-Reinforced, Lithium Disilicate)
✔ Require hydrofluoric acid (HF) etching, followed by a silane coupling agent.
✔ Protocols vary depending on ceramic type:
- Feldspathic: 9.8% HF for 2 min → silane → light-cured or dual-cured resin cement.
- Leucite-Reinforced: 9.8% HF for 1 min → silane → resin cement.
- Lithium Disilicate: 4.6% HF for 20 sec → silane → resin cement.
✔ These systems have shown survival rates of over 16 years in some studies.
2. Polymer-Infiltrated Ceramic Network (PICN)
✔ Surface treatment with 5% HF for 1 min or airborne particle abrasion (APA) with aluminum oxide → silane → resin cement.
3. Zirconia-Based Ceramics (Y-TZP and newer translucent types)
✔ HF is ineffective. The recommended bonding approach is the APC protocol:
- A: Airborne particle abrasion (APA)
- P: Primer containing MDP (10-Methacryloyloxydecyl dihydrogen phosphate)
- C: Dual-cure or self-cure resin cement.
✔ MDP-based primers ensure chemical bonding to metal oxides in zirconia, even for newer translucent zirconias (4Y, 5Y).
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Critical Surface Preparation Step
✔ After try-in procedures, cleaning the ceramic surface is essential to remove salivary contamination:
- Recommended agents: Alcohol, ultrasonic bath, Ivoclean®, or KATANA™ Cleaner.
Moisture Control
✔ Proper field isolation is mandatory to prevent bond degradation:
- Rubber dam, cotton rolls, high-volume suction, or an isolation system should be used during bonding.
The article concludes with a practical summary table, detailing step-by-step protocols for each material type—making it an excellent reference for daily practice
We invite dentists, prosthodontists, and dental students worldwide to read the Full article in PDF format and update their knowledge on state-of-the-art ceramic bonding techniques.
