International Academy for Adhesive Dentistry (IAAD)

Dear Members,
It is less than a year until our first Biennial Meeting
on 11 and 12 September, 2015 in Orlando and we
are moving forward as planned. Our congress partner,
Quintessence Publishing Co Inc., has produced a Save
the Date flyer, which will be widely distributed in the
coming months. The other good news is that all speakers are confirmed, and therefore the advance program
can go into production for the further advertising of our
meeting. We have decided that all IAAD members will
get a $200 discount on the meeting fee another good
reason for anyone interested in adhesive dentistry to
become a member.
I am proud to announce that we have initiated a poster
competition, and the call for posters is on our website
(www.adhesivedentistry.org). Please inform yourself
about the conditions and rules which apply to submitting
your poster online. We will accept any scientific reports,
as well as any outstanding clinical case presentations
dealing with adhesion. Furthermore, I am thrilled to announce that there will be two awards for the best poster:
The Presidents Award for the Best Student poster, and

the Fusayama IAAD Scientist Award for the Best Young

Researcher poster. Both winners will be awarded $1,000
plus free registration for our next meeting. Furthermore,
if the winners of the awards decide to publish the work
presented in their poster, they will be given priority in the
publishing pipeline, once their manuscript has been accepted.
And finally, the good news is that I attended the 3rd
Annual Meeting of the Academy of Biomimetic Dentistry
in Los Angeles and presented a short lecture about the
IAAD. I was impressed by the enthusiasm of this group.
Having basically the same objectives as the IAAD to
improve dentistry to best serve our patients we decided
to initiate talks about a cooperation between these academies. Hopefully, I will be able to tell you more about this
project soon.

Sincerely yours

Jean-Franois Roulet, President IAAD

Dont miss the first Biannual Meeting of the IAAD in Orlando on September 11th and 12th, 2015!

How to Repair Ceramic Chipping or Fracture in

Metal-Ceramic Fixed Dental Prostheses Intraorally:
Step-by-Step Procedures
Mutlu zcana
IAAD WORKING INSTRUCTIONS
Question: What is the best surface conditioning protocol
for the repair of ceramic chipping or fracture in metalceramic fixed dental prostheses intraorally?
Answer: Chipping or fracture of veneering ceramic in a
metal-ceramic fixed dental prosthesis (FDP) may involve

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.

Vol 16, No 5, 2014

metal exposure. To intraorally repair such a case, the

metal framework and the cohesively fractured veneering
ceramic need to be conditioned accordingly. Each substrate requires a different conditioning method with etching gels, adhesive promoters, and/or abrasives. Thus,
the sequence of the repair protocol may affect durable
adhesion of repair composite to these substrates.

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, CH-8032,
Zrich, Switzerland. Tel: +41-44-634-5600; Fax: +41-44-634-4305. e-mail:
mutluozcan@hotmail.com

491

Do

Why?

Control occlusion and eliminate premature contacts.

Chipping or fractures of veneering ceramic are the result of multiple factors, one of
which is the presence of premature contacts.5 This could be the underlying cause for
failure and should be eliminated prior to repair procedures.

Determine the color of the repair composite.

The color match between ceramic and resin composites, especially in the visible anterior
areas, is crucial, as the two materials have different surface properties and color stability.2

Place rubber-dam and modify it for long-span FDPs.

Rubber-dam will protect the soft tissues from hazardous hydrofluoric acid (HF) that
will be used later for conditioning the veneering ceramic.7

Clean both the ceramic and metal 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 veneering ceramic surface at the margins to

be repaired using a fine-grit diamond bur under water cooling and
create a bevel.

An undisturbed glaze layer with concentrated glass particles 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.10 The presence of glass phase in ceramics is known to
be crucial for better siloxane bonds.11

Coat the veneering ceramic except the bevelled area using glycerine gel.

Accidental deposition of particles during conditioning of the exposed metal by air

abrasion may remove the glaze on the veneering ceramic.

Air abrade the metal surface using a chairside air-abrasion device,

preferably with alumina particles coated with silica or silica only
(particle size range: 30 to 50 m; blasting pressure: 2.5 bar)
for approximately 5 s in circling motion, rotating the nozzle, until
the metal surface turns matte from a distance of approximately
10mm.8
Rinse under copious water and dry throughly.

Air abrasion of the metal surface cleans contaminants from the surface and roughens
metal. The alumina particles present a more amorphous pattern than silica-coated
alumina ones or silica particles, which then reacts with the subsequent silane layer.3
The nozzle distance of approx. 10 mm allows the particles to abrade a larger area. If
the nozzle is not rotated in circling motions, the surface is not evenly roughened.9
Rinsing removes the particles from the metal and ceramic surface and increases wettability of the HF and the silane.

Etch the ceramic margins where the repair composite will be adhered with 5% or 9.6% HF for 20 or 90 s, depending on the manufacturers instructions. Rinse for at least 60 s and dry.

HF selectively dissolves the glass matrix and provides an ideal surface pattern for
micromechanical retention.1

Apply one layer of silane coupling agent on both the metal and the
ceramic surface and wait for its reaction.

Silane coupling agents make covalent bonds (siloxane bonds) between the silica and
metal oxides present on the metal, and between silica on the ceramic and the organic
matrix as well as the opaque resin that will then be applied to mask the metal.11

As thinly as possible using the tip of the explorer, mask the metal
surface with opaque resin based on a powder-liquid system (mix
1:1; leave no air bubbles), making sure that it does not smear the
ceramic surface.

Powder-liquidbased opaque resins usually contain methylmethacrylate available in

different shades and present better wettability on the metal surface compared to
those in paste form.6

Photopolymerize the opaque resin layer longer than 40 s

(eg, 3x40).

The opaque layer is the weakest link in resin-metal adhesion. Powder-liquidbased

opaque resins are generally designed for laboratory use. Methylmethacrylate resins
are not polymerized sufficiently by photo-initiators in the presence of oxygen.4 Photopolymerization duration longer than 40 s can compensate this.5

Apply adhesive resin on the veneering ceramic only. Air thin from
ceramic towards the metal surface and photopolymerize for 20 s.

Opaque resin may be dissolved by the adhesive resin, contaminating the ceramic
surface.6

Apply resin composite incrementally, photopolymerize. Remove rubber-dam and check the occlusion. Make sure premature contacts
are eliminated. Finally, finish and polish the repair composite.

CAVE: In cases of cohesive failures only in the ceramic

without metal exposure, the steps involving etching with HF,
silanization, and adhesive resin application are sufficient.

REFERENCES
1.
2.

3.
4.

Calamia JR. Etched porcelain facial veneers: a new treatment modality

based on scientific and clinical evidence. NY J Dent 1983;53:255-259.
Gresnigt MM, Kalk W, zcan M. Randomized clinical trial of indirect
resin composite and ceramic veneers: up to 3-year follow-up. J Adhes
Dent 2013;15:181-190.
Guggenberger R. Rocatec system-adhesion by tribochemical coating.
Dtsch Zahnrztl Z 1989;44:874-876.
Matsumura H, Yoshida K, Tanaka T, Atsuta M. Adhesive bonding of
titanium with a titanate coupler and 4-META/MMA-TBB opaque resin. J
Dent Res 1990;69:1614-1616.

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5.

zcan M. Fracture reasons in ceramic-fused-to-metal restorations. J Oral

Rehabil 2003;30:265-269.
6. zcan M, Kumbuloglu O. Effect of composition, viscosity and thickness
of the opaquer on the adhesion of resin composite to titanium. Dent
Mater 2009;25:1248-1255.
7. 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.
8. zcan M. Air abrasion of zirconia resin-bonded fixed dental prostheses prior
to adhesive cementation: why and how? J Adhes Dent 2013;15:394.
9. zcan M, Raadschelders J, Vallittu P, Lassilla L. Effect of particle deposition parameters on silica coating of zirconia using a chairside airabrasion device. J Adhes Dent 2013;15:211-214.
10. 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.
11. Sderholm KJM, Shang SW. Molecular orientation of silane at the surface of colloidal silica. J Dent Res 1993;72:1050-1054.

The Journal of Adhesive Dentistry