Bonding to Silica-Based Ceramics:
Clinical and Laboratory Guidelines
Markus B. Blatz, DMD, PhD*
Avishai Sadan, DMD**
Matthias Kern, DMD, PhD***
ilica-based ceramics are widely used for
the fabrication of porcelain laminate ve-
neers, crowns, inlays, onlays, etc. Despite
the inherent brittleness of these ceramic materials,
such restorations derive their strength from the
adhesive bond of the definitive restoration to the
supporting tooth structure. This bond has two in-
terfaces: one is the bond between the composite
resin and the ceramic substrate; the other is the
bond between the composite resin and the tooth
structure. Since both the dental technician and
the restorative dentist affect the interface be-
*Assistant Professor, Department of Prosthodontics,
Louisiana State University Health Sciences Center, School
of Dentistry, New Orleans, Louisiana.
'"Associate Professor, Department of Prosthodontics,
Louisiana State University Health Sciences Center, School
of Dentistry, New Orleans, Louisiana.
""'Professor and Chairman, Department of Prosthodontics,
Propaedeutics and Dental Materials, Christian-Albrechts
university Kiel, School of Dentistry, Kiel, Germany.
Reprint requests: Dr Markus B. Blatz, LSU School of Den-
tistry, Department of Prosthodontics [Box 222), 1100 Florida
Avenue, New Orleans, LA 70119, USA,
E-mail: mblatz@lsuhsc.edu
tween the ceramic and the composite resin, this
article focuses on the bond between the two.
Proper understanding and treatment of this inter-
face by technicians and dentists are paramount to
the long-term success of silica-based ceramic
restorations.
• SIGNIFICANCE OF BONDING SILICA-BASED
CERAMICS
A strong bond provides high retention and im-
proved marginal adaptation, prevents microleak-
age, and increases fracture resistance of the re-
stored tooth and the restoration itself.'"* Modern
adhesive bonding techniques and ceramic sys-
tems offer a wide range of alternative, minimally
invasive treatment options that were previously
not possible. Adequate ceramic surface prepara-
tion and ceramic primers, silane, and bonding
agents establish the adhesive interface between
the composite resin and the ceramic surface. Sil-
ica-based ceramics, such as feldspathic ceramics
and glass ceramics, are used as the veneering ce-

ramie for metal frameworks (PFM) or high-strength
ceramic frameworks. They are also used to fabri-
cate ceramic laminate veneers, all-ceramic crowns,
and ceramic inlays and onlays.
Despite the inherent brittleness and limited flex-
ural strength of silica-based ceramics, final adhe-
sive cementation with composite resin increases
the fracture resistance of the ceramic and of the
abutment tooth.•* Reinforcing the glassy matrix with
leucite, alumina, or lirconia results in a significant
increase in fracture strength. Examples of leucite-
reinforced feldspathic ceramic materials are Optec
HSP and Optec OPC (Jeneric/Pentron, Walling-
ford, CT. USA), Ceramco II (Ceramco, Burlington,
NJ, USA), Cerinate (Den-Mat, Santa Maria, CA,
USA), Duceram LCF (Degussa, South Plainfield,
NJ, USA), and Finesse (Dentsply International,
York, PA, USA). IPS Empress (Ivoclar Williams,
Amherst, NY, USA) uses precerammed, leucite-
reinforced feldspathic ingots. The ingots are
heated and pressed into a refractory mold made
with the lost-wax technique. IPS Empress 2 uses a
lithium disilicate glass ceramic as a core and sin-
tered glass ceramic as a veneering material. IPS
Empress 2 offers high fracture strength that may
be adequate for fabricating short-span fixed partial
dentures (FPD).^ However, no long-term data on
the clinical outcome of such FPDs are available
yet. Other manufaaurers increase the contents of
aluminum oxide to fabricate strong ceramic cores
(eg, Hi-Ceram, Vita Zahnfabrik, Bad Säckingen,
Germany). Feldspathic ceramic can also be rein-
forced with zirconia fibers (Mirage II, Mirage Den-
tal Systems, Chameleon Dental Products, Kansas
City, KS. USA). Modern high-strength ceramics
contain almost exclusively aluminum or zirconium
oxide and therefore are not considered silica-
based ceramics. In general, any ceramic containing
less than 15 wt% silica is not regarded a silica-
based or silicate ceramic' These materials require
significantly different bonding procedures, since
they cannot be etched with hydrofluoric (HF) acid.
Silane coupling agents will not increase bond
strength because they lack silica. However, non-sil-
ica-based ceramics are not within the scope of this
article.
Bonding to Silica-Based Ceramics I
• SURFACE PREPARATION OF SILICA-BASED
CERAMICS
A sufficient resin bond relies on chemical bonding
and micromechanical interlocking with the ce-
ramic surface. Roughening and cleaning provide
higher surface energy and increased wettability.
Mechanical treatment methods, such as grind-
ing'"' and air abrasion with alumium oxide parti-
cles,'" may increase bond strength but are not
suitable for final insertion of all-ceramic restora-
tions due to possible marginal damage,"
Acid etching with solutions of HF acid or am-
monium bifluoride can achieve preferable surface
texture and roughness'^""; the acid selectively re-
moves the giassy matrix and exposes the crys-
talline structures. Etching with HF acid (2.5% and
5%) for more than 30 seconds significantly en-
hances bond strength to feldspathic ceramic.'^
Some have found etching with HF acid for 3 min-
utes to be the most successful,'* while others have
observed highest bond strength with 5% HF ap-
plied for 2 minutes." Shahverdi et al'° found that a
combination of sandblasting with the Microetcher
(Danville Engineering, San Ramon, CA, USA), HF
acid treatment, and silane application was most
successful. However, HF acid treatment seems to
be the critical step. Sandblasting alone provides
low and insufficient bond strengths'"" and may
damage restoration margins." However, for in-
traoral repair of fractured ceramic restorations,
sandblasting might be a sufficient method for cre-
ating micromechanical retention without exposing
the patient to the possible hazards of intraoral use
of HFacid.^'
APPLICATION OF SILANE COUPLING
AGENTS
Application of a silane coupling agent on the pre-
treated ceramic surface provides a chemical cova-
lent bond to silica-based ceramics."-^** This bond
seems to be stable after long-term water storage
and thermocycling." Silanes are bifunctional
molecules that bond silicone dioxide with the OH
BLATZ ET AL
groups on the ceramic surface on one side and
also have a degradable functional group that
copolymerizes with the organic matrix on the
other side,'""" Silane coupling agents usually con-
tain a silane coupler and a weak acid, which en-
hances the formation of siloxane bonds,'""
To investigate the ceramic-composite resin in-
terface, Sorensen et aP tested microleakage and
found that ceramic etching and silanization signif-
icantly decreased microleakage. However, silane
treatment without ceramic etching did not re-
duce microleakage. Contamination of an etched
and silanated restoration during try-in might re-
duce bond strength,'^ If restorations have to be
tried in clinically after surface conditioning in the
laboratory, it is important to remove any contami-
nants from the bonding surface prior to final
b o n d i n g . For this purpose, phosphoric acid
seems to be more efficient than solvents such as
acetone or alcohol,"^ In one study, chairside re-
silanation of a laboratory-conditioned restoration
and the use of trial resin pastes had little or no
effect on the resin-ceramic bond," However, hy-
drofluoric acid gels, which are user friendly, allow
for chairside etching and silanization of the ce-
ramic bonding surface after completion of all try-
in procedures and alterations, and seem to be a
safer and more practical approach. Since etching
agents vary in concentration and silane couplers
may have different contents, it is of paramount
importance to follow manufacturer's instructions
for application procedures and timing. Silane
coupling agents are dispensed in single-bottle or
multiple-bottle applications and usually contain
high amounts of solvents," Single-bottle prod-
ucts are susceptible to rapid evaporation of sol-
vents. Therefore, one should seal containers im-
m e d i a t e l y after use and keep in mind the
recommended shelf life. Some manufacturers
add a silane coupler to their bonding system that
can be mixed with the other components (eg,
Clearfil New Bond and Clearfil New Bond Porce-
lain Activator, Kuraray, Osaka, Japan),
" COMPOSITE RESIN CEMENTS
Various characteristics of the ceramic restoration,
such as type, indication, site, shade, thickness,
and opacity, influence the selection of the com-
posite resin cement. The curing mode [chemical-,
light-, or dual-curing), composition, and viscosity
of the resin cement influence the handling and
physical properties ofthe bond between the com-
posite resin and the ceramic substrate. Tensile
bond-strength tests demonstrated no difference
between various dual-cure resin cements in bond-
ing glass ceramics to enamel,'" In one study, dual-
cure resin cements demonstrated better bond
strength than autopolymerizing resin cements,"
Bond strengths of all groups peaked 7 days after
cementation. However, these results cannot be
used for a general conclusion due to the limited
number of tested resin cements. Two studies
agreed that filler-containing resin cements
demonstrate higher bond strengths to ceramic
than resin cements without fillers,^^'" Hybrid com-
posites showed better results than microfilled
composites,"' In an in vitro study, Hahn et a l "
found that highly viscous resin cements used for
the cementation of ceramic inlays demonstrated
significantly less microleakage at the dentin-com-
posite interface than low-viscosity resin cements.
Resin-modified glass-ionomer cements applied to
etched and silanated feldspathic ceramic showed
bond strengths comparable to composite resin
cements.™
W SILICA-BASEO CERAMIC MATERIALS
The number, size, and distribution of leucite crys-
tals have a significant influence on the formation
of microporosities that acid etching creates,'*'^'
Leucite crystals grow during the ceramic-firing
process, and the content of leucite in a veneering
ceramic determines the coefficient of thermal ex-
pansion of the ceramic and therefore its compati-
bility with and bond to a specific alloy. Some low-
fusing ceramics and glass ceramics contain little or
no leucite. When acid etching with HF acid solu-

tions, little or no leucite seems to inhibit the for-
mation of highly retentive microporositles.^^^'
However, Maltezos et a l " observed no difference
in strengths of resin bonding to a synthetic,
leucite-reinforced feldspathic ceramic or to a con-
ventional feldspathic ceramic. Acid etching with
5% HF gel for 120 seconds or 9% HF for 60 sec-
onds was most successful for leucite-reinforced
feldspathic ceramic, such as the pressed ceramic
IPS Empress.-""" Independent from surface con-
ditioning, significantly higher bond strengths were
achieved with a lithium disilicate glass ceramic
(IPS Empress 2) than with leucite-reinforced IPS
Empress." This might be related to the higher
flexural strength and fracture toughness of the dis-
ilicate ceramic, which prevents a cohesive ceramic
failure at the bonding surface.
m TESTING CONDITIONS
Bond strength of composite resin to ceramic mate-
rials is usually evaluated with the three-point-bend-
ing, tensile, microtensile, or shear bond strength
test.^"' Water storage^^ and thermocycling are ac-
cepted methods for the simulation of the aging of
and for stressing the bonding interface. Some
studies that included thermocycling and/or long-
term storage in water revealed significant differ-
ences between early and late bond-strength re-
sults." Kato et al*^ reported significant changes in
the bond strength of various bonding systems
after 20,000 cycles of thermocycling. The same
group found significant reduction in bond strength
for a luting cement after 20,000 cycles but stable
results for another cement, regardless of surface
treatment," Another study evaluated the durability
of the resin bond of several bonding systems to
Empress ceramic after 150 days of water storage
and 37,500 thermocycles. The systems under in-
vestigation provided stable bonds to the HF acid-
etched and silane-coated ceramic.^'
Bonding to Silica-Based Ceramics I
• CLINICAL ANO LABORATORY
RECOMMENOATIONS
Most studies recommend acid etching of the ce-
ramic surface with an HP acid solution for adhesive
cementation of silica-based ceramic restorations.
Commercial products offer solutions of 4% to 9.8%
HF; the most convenient form to use is a gel. De-
pending on the product and the ceramic substrate,
the acid etching gel is usually applied for at least 2
minutes and then rinsed off with water. If the
restoration is exposed during clinical try-in to any
organic contaminants, such as saliva, blood, or a
silicone fit-checking medium, 15 seconds of phos-
phoric acid etching is an effective method to re-
move the organic contaminants pnor to HF acid
etching. Organic contaminants may negatively af-
fect etching patterns and decrease bond strength
to ceramic materials. After HF acid etching, a
silane coupling agent should be applied. Some
manufacturers add a silanating agent to their
bonding system. One should read and follow the
manufacturer's instructions carefully and stay within
one system, since components of different bond-
ing systems may not be interchangeable. The
silane coupling agent has to be compatible with
the bonding agent and the resin cement.*'
Modern bonding techniques provide a pre-
dictable and durable mechanochemical adhesive
bond to silica-based ceramics. Most laboratory
studies report bond strengths that exceed the
fracture resistance of the ceramic (cohesive fail-
ure).'"' Long-term clinical success rates of resin-
bonded silica-based ceramic restorations, such as
porcelain laminate veneers""' and all-ceramic in-
lays/onlays,'**^ are good to excellent. All-ceramic
full-coverage crowns made of leucite-reinforced
feldspathic porcelain seem to have good clinical
longevity when they are adhesively cemented."
Presently, there are no studies on the long-term
clinical success of adhesively cemented silica-
based ceramic FPDs available, neither crown- nor
inlay-retained.
The flowchart on the following page illustrates
the recommended bonding steps in a consecutive
order. Figures 1 to 6 show clinical examples of
bonded silica-based restorations.
QDT 2002
BLATZ ET AL

TREATMENT OF SILICA-BASED CERAMIC SURFACES FOR BONDING

Denial Laboratory Dental Office

GT ail-ceramic restoi ation

Option A: Do nol elch

No

Option B: Etch
'HOirrögenöus trosry
appearance

No Yes Yes

Cleaning:
phosphoric acid etching
or alcohol / acetone
 Bonding to Silica-Based Ceramics

Figs la and 1b Preoperative occlusal views of maxillary and mandibular arches demonstrating
excessive tooth wear of the anterior dentition due to bruxism.

Fig 2 Preoperative occlusal view of mandibular anterior
teeth Lengthening these teeth necessitated the alter-
ation ofthe vertical dimension of occlusion.
Fig 3 Try-in of posterior maxillary restorations. The max-
illary incisors were restored with full-coverage silica-
based all-ceramic restorations. All teeth posterior to the
incisors were restored with ceramic-fused-to-metal full-
coverage restorations.

Fig 4 Try-in of posterior mandibular restorations. The

mandibular anterior teeth ¡canine to canine] were re-
stored with silica-based ceramic laminate veneers. All
posterior teeth were restored with porcelain-fused-to-
metal full-coverage restorations.
 BLATZ ET AL

Fig 5a and 5b Four-year postoperative occiusal views of maxillary and mandibular arches. Note
that the only complication is slight chipping of the distobuccal cusp of maxillary second molar
(porcelain-fused-to-metai restoration).

Fig 6 Four-year postoperative buccal view of

maxillary anterior restorations. Incisors are re-
stored with full-coverage silica-based all-cerarnic
restorations. (Inset) Preoperative buccal view.
(Clinical case by Avishai Sadan, DMD, and Ger-
ard Chiche, DDS, LSU School of Dentistry.)

P i CONCLUSION ACKNOWLEDGMENTS

Adequate intaglio surface preparation of silica-
based ceramic restorations with HF acid etching
and silane application provides predictable and
durable bond strengths between composite resin
cements and the ceramic substrate.
The authors would like to acknowledge the following people
for their support and contribution: (ÎJ technique case
in flowchart. Chuck Thompson, Thompson Dental Studio,
Ellisvill, Mississippi; I2¡ anterior maxillary restorations in dinicai
case, Hitoshi Aoshima, Japan, Í3J posterior maxillary and
mandibular restorations in dinicai case, Leah Fox, Thompson
Dental Studio, Ellisvill, Mississippi.

QDT 2002

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