Effect of different surface treatments on shear bond strength of zirconia to three resin cements

Statement of problem: There are no standard guidelines for material selection to obtain acceptable bonding to high-strength zirconium oxide ceramic. Studies suggest resin cements in combination with MDP-containing primer is a reasonable choice, however, the other cements cannot be rejected and need further investigation.;Objective: The purpose of this in vitro study was the evaluation of the shear bond strength of three composite resin cements to zirconia ceramic after using different surface conditioning methods.;Materials and methods: One hundred and twenty sintered Y-TZP ceramic (IPS e.max ZirCAD) squares (8 x 8 x 4 mm) were embedded in acrylic molds, then divided into three groups (n=40) based on the type of cement used. Within each group, the specimens were divided into four subgroups (n=10) and treated as follows: (1) Air abrasion with 50microm aluminum oxide (Al2O 3) particles (ALO); (2) Air abrasion + Scotchbond Universal adhesive (SBU); (3) Air abrasion + Monobond Plus (MBP); (4) Air abrasion + Z-Prime Plus (ZPP). Composite cylinders were used as carriers to bond to conditioned ceramic using (1) RelyX Ultimate adhesive resin cement (RX); (2) Panavia SA self-adhesive resin cement (PSA); (3) Calibra esthetic cement (CAL). The bonded specimens were submerged in distilled water and subjected to 24-hour incubation period at 37°C. All specimens were stressed in shear at a constant crosshead speed of 0.5 mm/min until failure. Statistical analysis was performed by ANOVA. The bond strength values (MPa), means and standard deviations were calculated and data were analyzed using analysis of variance with Fisher's PLSD multiple comparison test at the 0.05 level of significance. The nature of failure was recorded.;Results: The two-way ANOVA showed Panavia SA to have the highest strength at 44.3 +/- 16.9 MPa (p<0.05). The combination of Scotchbond Universal surface treatment with Panavia SA cement showed statistically higher bond strength (p=0.0054). The highest bond strengths for all three cements were observed with Scotchbond Universal surface treatment (p=0.0041). Calibra in combination with aluminum oxide air abrasion resulted in statistically lowest bond strength at 12.0 +/- 3.9 MPa. The predominant mode of failure was cohesive with cement remaining principally on the zirconium oxide samples in 57.5% of the specimens, followed by cement found on both the zirconium oxide samples and composite rods (mixed) in 32.5% of the samples. Only 10% of the specimens were found with cement on the composite rods (adhesive failure).;Conclusions: Within the limitations of this in vitro study, the MDP-containing resin cement, Panavia SA, yielded the strongest bond to Y-TZP ceramic when compared to adhesive (RelyX Ultimate) or esthetic (Calibra) resin cements. Air abrasion particle + Scotchbond Universal surface treatment demonstrated the highest bond strength regardless of the cement.;Significance: The variation of surface conditioning methods yielded different results in accordance with the cement types. Overall, Scotchbond Universal adhesive + air abrasion yielded the highest bond strengths among all three surface treatments. The phosphate monomer-containing luting system, Panavia SA, is acceptable for bonding to zirconia ceramics.