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Know the Facts Before Bonding

Indirect Restorations
BOSTON, MA - Although the trend in dentistry has (Dr. Suh said if the etched porcelain is overetched, it
been moving toward simplified procedures, clinicians do should be cleaned by the lab using steam, ultrasonic
not want to sacrifice quality restorations for simplicity. bath or by agitatating with phosphoric acid.);
Bonding indirect restorations poses some particular is- 2. Apply 1 to 2 coats of silane and dry with warm air;
sues for clinicians, as there are several myths surrounding 3. Try-in the restorations.
bonding to indirect substrates such as porcelain, zirconia, 4. Clean with alcohol and dry.
and alumina. 5. Apply bonding resin to porcelain (Dr. Suh indicated that
Byoung I. Suh, PhD, told an audience at the Yankee this step is optional based on the clinicians preference).
Dental Congress that 1 of the challenges in dealing with 6. Apply bonding agent to tooth.
indirect restorations is dispelling these myths, like, that 7. Cement restoration.
all silanes are the same” or “you can’t bond to zirconia.”
As the founder and president of Bisco Dental Prod- Etch, Cement Choices
ucts Inc. in Schaumburg, IL, Dr. Suh spoke at the con- Dr. Suh notes that the choice of an etch will influ-
ference to share some pearls with the attendees on ence how best to proceed when managing indirect res-
bonding to zirconia and porcelain; he offered some tips torations. Total-etch adhesives require phosphoric acid
on immediate dentin sealing as well. etching and are applied in 1 or 2 layers, the self-etch
adhesives have the acid built into the adhesive. The
Bonding to Zirconia etch-and-rinse category includes both 3-step and 2-step
When bonding to zirconia restorations, Dr. Suh told adhesives (such as One-Step Plus) that remove the smear
Congress attendees that zirconia primer should be used to layer; whereas the etch-and-dry category includes 2-
make the surface hydrophobic and chemically bondable. and 1–step adhesives, such as All Bond SE, that modify
He advised attendees to avoid grinding or sandblasting. the smear layer without removal.
However, he said, if minor adjustments are needed to Choice of cement also will influence the outcome,
use the finest diamond instrument possible, polish with Dr. Suh said. He explained that there are several types
diamond paste, and seal with a zirconia primer. With re- of luting cements on the market, including light-cure
gard to technique, Dr. Suh suggested the following steps: only, which is generally more for veneers or thin resto-
1. Clean internal surface of restoration by lightly sand- rations that light can penetrate, and dual-cured, which
blasting with 30-50 grit at 2 to 3 bars. is for restorations where light cannot penetrate such as
2. Apply 1 to 2 coats of zirconia primer (ie Bisco’s Z- deep inlays/onlays or crowns.
Prime Plus).
3. Try-in the restorations. An Important Step
4. Clean and dry. Dr. Suh also reviewed the benefits of immediate den-
5. Apply a total etch or self etch bonding agent on the tin sealing, which he said include:
tooth prep. 1. Protecting the pulp from bacteria and contamination
6. Cement the restoration. during temporization.
2. Allowing for a stable and mature hybrid layer.
Porcelain Pearls 3. Providing patient comfort during temporaries and
For bonding to porcelain, Dr. Suh noted that it is im- final placement.
portant to remember that silane is chemically unstable Dr. Suh urged clinicians to pay careful attention to
over time; therefore, he said, consider the individual use etching, cementing, and bonding materials, and to let the
of silane when purchasing these systems. “If you do not individual clinicians’ preference, coupled with patient
use a lot of silane, buy a 2-bottle system; if you use needs, guide the treatment approach. —Colleen Platt
silane daily, 1 bottle is fine,” he said. Porcelain primer
is used to alter the surface of the porcelain from hydro- Byoung Suh PhD
philic to hydrophobic. Dr. Suh is the founder and president of Bisco Den-
tal Products Inc. With a background in research and
Dr. Suh suggests the following technique for bonding chemistry, Dr. Suh’s focus at Bisco is on dental materi-
porcelain veneers or inlays/onlays: als research and product development.
1. Clean the surface prep with phosphoric acid and
rinse the HF-etched restorations received from the lab

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