Influence of surface treatments and resin cement selection on bonding to densely-sintered zirconium-oxide ceramic

OBJECTIVES: To evaluate the effect of surface conditioning on the microtensile bond strength of zirconium-oxide ceramic to dual-cured resin cements. METHODS: Eighteen cylinder-shaped zirconium-oxide ceramic blocks (Cercon Zirconia, Dentsply) were treated as follows: (1) Sandblasting with 125 microm aluminum-oxide (Al(2)O(3)) particles; (2) tribochemical silica coating using 50 microm Al(2)O(3) particles modified by silica; (3) no treatment. Each ceramic cylinder was duplicated in composite resin (Tetric Evo Ceram, Ivoclar-Vivadent) using a silicon mold. Composite cylinders were bonded to conditioned ceramics using: (1) Calibra (Densply Caulk); (2) Clearfil Esthetic Cement (Kuraray); (3) Rely x Unicem (3M ESPE). After 24h bonded specimens were cut into microtensile sticks that were loaded in tension until failure. Data were analyzed using two-way ANOVA and Student-Newman-Keuls test for multiple comparisons (p<0.05). Failure mode was recorded and the interfacial morphology of debonded specimens was observed using a scanning electron microscope (SEM). Surface topography and ceramic average surface roughness were analyzed under an atomic force microscope (AFM). RESULTS: Significant changes in zirconia surface roughness occurred after sandblasting (p<0.001). Bond strength of Clearfil cement to zirconia was significantly higher than that of Rely x Unicem and Calibra, regardless of the surface treatment (p<0.001). When using Calibra, premature failures occurred in non-treated and silica coated zirconia surfaces. SIGNIFICANCE: The phosphate monomer-containing luting system (Clearfil Esthetic Cement) is recommended to bond zirconia ceramics and surface treatments are not necessary.