Surface Conditioning Protocol for Multiple Substrates

in Repair of Cervical Recessions Adjacent to Ceramic

Mutlu zcana

Do

Why?

IAAD WORKING INSTRUCTIONS

Place rubber-dam and

retract the gingiva at
the cervical area with
retraction cord.

For better visibility and finishing of the

repair composite. Rubber-dam will protect the soft tissues from hazardous
hydrofluoric acid (HF).3

Clean both the

cervical tooth and
the ceramic surface
using fluoride-free
paste or pumice.

Etching gels and adhesive promoters

should have direct contact with the substrates for effective conditioning. Clean
surfaces are essential in all adhesive
procedures.

Remove glaze of the

ceramic surface at
the margins using
fine-grit diamond
bur under water
cooling.

Undisturbed glaze layer will not react

with HF and subsequent application
of silane coupling agents. Removal of
glaze layer increases the surface area
on ceramic for mechanical retention and
allows the reaction of silane with the
glassy matrix.7 The presence of glass
phase in ceramics is known to be expedient for better siloxane bonds.1

First, etch cervical

tooth surface with
phosphoric acid for
30 s, rinse and dry.
Then etch the ceramic margins with
5% or 9.6% HF for
20or 90 s, depending on the manufacturers instructions.
Rinse for at least
60s and dry.

HF application to condition glass ceramics may contaminate the exposed etched

enamel or dentin surfaces at the cervical
area during application or rinsing of HF.
When fluoride reacts with Ca in dentinal
tubules, CaF2 is formed and dense amorphous precipitates of fluoride occlude the
tubules, and the collagen in the peritubuler zone is denatured.10 Furthermore,
HF cannot dissolve the smear layer and
no dentin hybridization can be accomplished on HF treated dentin.6 Starting the
repair action with enamel/dentin conditioning with the application of phosphoric
acid diminishes the possible contamination and inhibiting effect of HF on the
bond strength of repair composite.8

Question: What is the best surface conditioning protocol

sequence for adjacent multiple substrates in repair of
cervical recessions next to ceramic?
Answer: Intraoral repairs of all-ceramic fixed dental
prostheses (FDP) after long-term service may include
cervical recessions that require conditioning of the exposed tooth surfaces next to ceramic. Each substrate
requires a different conditioning method with etching
gels and adhesive promoters, and the repair protocol
sequence may cross contaminate the exposed enamel
or dentin surfaces, thereby negatively influencing durable adhesion.
CAVE: In the case of metal-ceramic FDPs where the
metal framework is exposed, it is advisable to rinse, dry,
and silica coat the metal surface. The tooth part should
be etched with phosporic acid, and then the ceramic
part should be HF etched.2 On the exposed metal and
the ceramic, a universal multimode adhesive could be
applied.4 After this, primer and adhesive resin should be
applied on the tooth surface.

Apply silane coupling agent on the

ceramic surface
and wait for its reaction.

Silane coupling agents make covalent

bonds between the silica oxides present
on ceramics and the organic matrix of
resin cements by means of siloxane
bonds.9

Apply primer and

adhesive resin on
the tooth surface
depending on the
presence of dentin.

A multistep etch-and-rinse adhesive

system can produce adhesion even to
the less retentive cervical enamel and
exposed dentin.5

Professor, Clinic for Fixed and Removable Prosthodontics and Dental Materials Science, Dental Materials Unit, Center for Dental and Oral Medicine,
University of Zrich, Zrich, Switzerland.

Correspondence: Professor Mutlu zcan, Clinic for Fixed and Removable

Prosthodontics and Dental Materials Science, Dental Materials Unit, Center
for Dental and Oral Medicine, University of Zrich, Plattenstrasse 11, CH8032, Zrich, Switzerland. Tel: +41-44-634-5600; Fax: +41-44-634-4305.
e-mail: mutluozcan@hotmail.com

394

REFERENCES
1.

Amaral R, zcan M, Bottino MA, Valandro LF. Microtensile bond

strength of a resin cement to glass infiltrated zirconia-reinforced ceramic: the effect of surface conditioning. Dent Mater 2006;22:283-290.
2. zcan M. The use of chairside silica coating for different dental applications: a clinical report. J Prosthet Dent 2002;87:469-472.
3. zcan M, Allahbeickaraghi A, Dndar M. Possible hazardous effects
of hydrofluoric acid and recommendations for treatment approach: a
review. Clin Oral Investig 2012;16:15-23.
4. Perdigo J, Loguercio AD. Universal or multi-mode adhesives: Why and
how? J Adhes Dent 2014;16:193-194.
5. Peumans M, Van Meerbeek B, Yoshida Y, Lambrechts P, Vanherle G.
Porcelain veneers bonded to tooth structure: an ultra-morphological
FE-SEM examination of the adhesive interface. Dent Mater 1999;15:
105-119.
6. Pioch T, Jakob H, Garca-Godoy F, Gtz H, Drfer CE, Staehle HJ. Surface characteristics of dentin experimentally exposed to hydrofluoric
acid. Eur J Oral Sci 2003;111:359-364.
7. Sarac YS, Kulunk T, Elekdag-Turk S, Sarac D, Turk T. Effects of surfaceconditioning methods on shear bond strength of brackets bonded to different all-ceramic materials. Eur J Orthod 2011;33:667-672.
8. Saracoglu A, zcan M, Kumbuloglu O, Turkun M. Adhesion of resin
composite to hydrofluoric acid-exposed enamel and dentin in repair protocols. Oper Dent 2011;36:545-553.
9. Sderholm KJM, Shang SW. Molecular orientation of silane at the surface of colloidal silica. J Dent Res 1993;72:1050-1054.
10. Szep S, Gerhardt T, Gockel HW, Ruppel M, Metzeltin D, Heidemann D.
In vitro dentinal surface reaction of 9.5% buffered hydrofluoric acid in
repair of ceramic restorations: A scanning electron microscopic investigation. J Prosthet Dent 2000;83:668-674.

The Journal of Adhesive Dentistry