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Conventional approaches to adhesive bonding are not applicable to zirconia restorations. Recently, an etching solution, Zeta Etching Solution (ZES), has been introduced for etching the surface of zirconia. The effects of this etching solution on the bond strength and mechanical properties of zirconia are unknown.The purpose of this in vitro study was to examine the effects of ZES on the bond strength and surface hardness of zirconia.Two different types of partially stabilized tetragonal polycrystalline zirconia (TZP), Prettau zirconia (group P) and anterior Prettau (group AP), were evaluated with and without ZES etching. Each group was bonded to a zirconia substrate by using an adhesive resin cement. After 24 hours of storage in distilled water, the bond strength of the zirconia was analyzed. Vickers hardness was determined by using a microhardness tester. Scanning electron microscopy was used to analyze the surface microstructure and determine the mode of failure for each specimen. Results were analyzed and compared using 1-way ANOVA and Student t tests (α=.05).Scanning electron microscopy analysis showed that etching the surface of zirconia with ZES etching solution for 60 minutes changed the morphological characteristics and microstructure of zirconia, making the surface more irregular. The changes were more pronounced for AP specimens. Etching with ZES significantly increased the shear bond strength of zirconia (P.05) in AP specimens. The bond strength of Prettau (P group) specimens after ZES etching did not increase significantly (P.05). An adhesive failure mode was observed for P zirconia specimens, whereas zirconia specimens exhibited a cohesive mode of failure. No significant decrease (P.05) was observed in the mean Vickers hardness numbers.Within the limitations of this in vitro study, it was concluded that etching in ZES for 30 minutes significantly enhanced the shear bond strength of highly translucent anterior Prettau (AP) zirconia restorations. Moreover, etching with ZES did not adversely affect the surface hardness of the zirconia specimens tested.

Achieving an optimal esthetic result when replacing missing teeth with implant-supported restorations in the esthetic zone is a demanding surgical and restorative challenge. This clinical report describes the use of a cantilevered, cemented, implant-supported restoration with gingiva-colored ceramics and a circumferential pressure-ridge lap pontic to replace 2 incisors and the adjacent tissue.

The mandibular implant-supported fixed restoration is an appropriate treatment choice for patients with inadequate bone volume in the posterior mandible. Computer-aided design/computer-aided manufacturing (CAD/CAM) technology has broadened the scope and application for this treatment option. A milled titanium bar retaining individual all-ceramic zirconium oxide crowns, with composite resin replicating gingival tissues, is recommended as an acceptable variation for this type of prosthesis. An alternative method for fabricating a mandibular implant-supported fixed restoration using CAD/CAM technology is described. (J Prosthet Dent 2009;102:271-278)

This clinical report demonstrates how a clinician can objectively overcome some of the barriers associated with providing patients with predictable esthetics, in a mutually satisfactory manner. Two such barriers are identified and discussed. The first is related to psychology and patient attitude to treatment. The second is related to the actual clinical procedure. A direct mock-up technique is described which serves as an effective communication tool between the dentist, patient, and dental laboratory technician. (J Prosthet Dent 2008;99:333-339)

Statement of problem Immediate dentin sealing (IDS) is a new approach in indirect restorations. Dentin is sealed immediately following tooth preparation, prior to impression making. It is not known whether it is still possible to obtain an efficient bond between the resin-coated dentin and the restoration after 2 to 4 months of placement of provisional restorations. Purpose The purpose of this study was to determine if there were differences in microtensile bond strength to human dentin using the IDS technique when comparing 2, 7, and 12 weeks of delay until restoration placement, using 2 different dentin bonding agents (DBAs). Previously published preliminary IDS data were included for comparison. Material and methods Fifty freshly extracted human molars were obtained and divided into 10 groups. A 3-step etch-and-rinse DBA (Optibond FL) and a 2-step self-etching DBA (SE Bond) were used. For each DBA, the control (C) specimens were prepared using a direct immediate bonding technique and composite restoration (Z100). Preparation of the other specimens used an indirect approach without dentin prebonding (delayed dentin sealing, DDS) or with immediate dentin sealing (IDS), immediately following preparation. IDS teeth had provisional restorations (Tempfil inlay) placed for 2 weeks (IDS-2W), 7 weeks (IDS-7W), or 12 weeks (IDS-12W) before restoration placement. All teeth were prepared for a nontrimming microtensile bond strength test (MTBS) 24 hours after definitive restoration with composite overlays (Z100). Ten to 11 beams (0.9 × 0.9 × 11 mm) from each tooth were selected for testing. MTBS data obtained from the 10 experimental groups were analyzed with a 2-way analysis of variance (ANOVA, dentin bonding system, and sequence of application) with each tooth (mean MTBS from the 10-11 beams) used as a single measurement. The Tukey HSD post hoc test was used to detect pairwise differences among experimental groups (α=.05). Fractured beams were also analyzed under stereoscopic microscope (x 30) and SEM. Results For both adhesives, the mean microtensile bond strengths of C and all IDS groups were not significantly different and exceeded 45 MPa. DDS groups exhibited lower bond strength than all others sequences ( P P =.026) than Optibond FL at 11.58 MPa. The highest mean microtensile bond strength values were found with Optibond FL at 7 weeks (66.59 MPa) and 12 weeks (59.11 MPa). These were significantly higher than SE Bond in the same conditions with values of 51.96 MPa and 45.76 MPa ( P =.001 and P =.003), respectively. Failures in DDS groups were all interfacial and purely adhesive. Both C and IDS-2W groups demonstrated interfacial failure that was typically mixed with both areas of failed adhesive resin and areas of cohesively failed dentin while IDS-7W and IDS-12W failed consistently between the existing resin coating (used during IDS) and the overlaying composite resin. Conclusions When preparing teeth for indirect bonded restorations, IDS with a 3-step etch-rinse or a 2-step self-etching DBA (prior to impression making) results in microtensile bond strength similar to that obtained with a freshly placed adhesive. The bond strength is not affected by up to 12 weeks of elapsed time prior to placement of the definitive restoration. (J Prosthet Dent 2007;98:166-174)