F7 Cements

Lecture 8: Biomaterials (Cements)¹

Cements²

Divided into temporary and permanent cements.

• Temporary cements such as zinc oxide eugenol/eugenol free cements covered in temporization.

Permanent cements can then be classified in many ways:

• Composition:
  • Resin based vs water based (GIC, zinc polycarboxylate and zinc phosphate)
• Compomers
• Bonding mechanism:
  • Non-adhesive luting vs micromechanical retention vs molecular adhesion

Luting³

“A term sometimes used to refer to final placement of a fixed prosthodontic restoration is to “lute” the restoration. It derives from the Latin lutum, which means mud or clay. A “luting agent” is the substance—such as cement, wax, or clay—that coats a joint area to make a tight seal. Historically, luting agents were used to mechanically link restorations to a prepared tooth.”

• Luting cements work based of mechanical friction by

• Traditionally for cast restorations with highly parallel preparations, which make removal nearly impossible without fracturing the cement.

  • They have no molecular adhesion.

Analogy

Similar to pressing two pieces of sandpaper together; the friction between the rough surfaces makes them difficult to slide against each other. The set cement acts as the gritty particles. Zinc Phosphate is a classic luting cement.

• Traditionally for cast restorations
• The luting cement powder sets into a hardened matrix
• However, luting cements generally have solubility issues due to the matrix consisting of ionic salts

Micromechanical bonding⁴

• Resin cements
• Etching dentin/enamel (Phosphoric acid)

Note

Similar to direct composite bonding, phosphoric acid is used to etch the dentin, removing superficial minerals and exposing the collagen fibril network. An adhesive (uncured resin monomers) is then infiltrated into this network and cured, creating a “hybrid layer” of interlocked resin and collagen.

• Etching glassy ceramics (hydrofluoric acid)

Note

The HF selectively dissolves the glassy silica phase of the ceramic, creating surface roughness and microporosities for the cement to lock into.

• Sand blasting metal/zirconia crowns
  • These materials cannot be etched with HF acid. Airborne particle abrasion with materials like aluminum oxide is used to create a rough, opaque surface, increasing the surface area for mechanical interlocking.

Molecular adhesion⁵

• Physical forces such Van der Waals or chemical ionic bonding.
• 10-MDP
• At the moment cements still require other methods of retention (parallel walls)
• Can not rely solely on this.

Current Status

Molecular adhesion alone is not sufficient for retention. It is used in combination with retentive preparation features (e.g., parallel walls) and micromechanical bonding to achieve durable clinical outcomes.

Ideal Properties of Cements⁶

• Low film thickness
• Suitable working time and setting time
• High compressive strength
• Similar elastic modulus as dentin
• Biocompatible
• Plaque/caries inhibition
• Low solubility
• Low microleakage
• Easy removal of excess
• High retention

Biocompatible and Antimicrobial Effects⁷

• Cements should ideally not interact with bodily tissues, and not cause sensitivity or allergic reactions
• Antimicrobial effects to prevent marginal caries. However evidence in inconclusive whether low level fluoride or other antimicrobial agents can provide long term inhibition. (Will the fluoride etc still be there in 10 years?)

Fluoride Release in GIC

GICs contain fluoride and are theorized to act as a “fluoride bank,” releasing it into the oral environment and “recharging” during brushing. However, it is uncertain if therapeutic levels are maintained over the long term.

Suitable working and setting time⁸

• Ideally enough time to mix the cement, seat and clean up excess in appropriate time
• Benefit of tack cure resin cement.

Note

Resin cements offer the advantage of “command set” or “tack curing,” allowing the clinician to initiate the set when ready.

• However if excess resin cement is not fully removed before final cure, will be extremely hard to remove excess

Microleakage/Solubility⁹¹⁰

• Solubility of cements in the oral environment (water) can lead to microleakage at the marginal interface and possible loss of retention.
• Zinc phosphate and zinc polycarboxylate have high solubility
• Resin cements have low solubility

Fleck = zinc phosphate cement

**HOWEVER ITS NOT APPROPRIATE TO SAY RESIN CEMENTS ARE PERFECT

Correlation vs. Causation

The link between solubility and microleakage is not definitive in the literature. Some studies find no significant difference in microleakage between high-solubility (e.g., zinc phosphate) and low-solubility (resin) cements, while other studies show a clear correlation.

**

Microleakage of Four Dental Cements in Metal Ceramic Restorations With Open Margins Reza Eftekhari Ashtiani, Babak Farzaneh, Mohadese Azarina, Farzad Aghdashi, Nima Dehghani, Alisooda Afshari, and Minu Mahshid

Film thickness¹¹

• Low film thickness preferred
• ADA states a maximum film thickness of 25um for luting cements
• Associated with better seating of crown and possibly lower marginal discrepancies.

Correlation with Bond Strength

==Some studies show a strong negative correlation between film thickness and microtensile bond strength, suggesting a thinner cement layer leads to a stronger bond.==

Elastic modulus and compressive strength¹²

• If cement has a similar elastic modulus as dentin, there will be less stress concentration at the interface
• Some studies claim that fracture of ceramic restoration begin at the cement layer.
• Fracture load of zirconia crowns may not be greatly affected by cement type

Zirconia Study

One study found that although zinc phosphate had significantly lower compressive strength than two resin cements, there was no significant difference in the final fracture strength of the zirconia crowns cemented with them.

• However chemical adhesion may be more important for lithium disilicate crowns

Weak adhesion between ceramic and resin cement impairs the load-bearing capacity under fatigue of lithium disilicate glass-ceramic crowns

Compressive Strength¹³

According to Rosenstiel SF, et al. in “Dental luting agents: a review of the current literature,” higher strength values were reported with the resin cements and glass ionomers than with zinc phosphate or polycarboxylate. Resin-modified glass ionomer exhibited greater variation than did other cements.

Summary

• ==Zinc Phosphate has one of the lowest compressive strengths and is often used as a benchmark for comparison.==
• ==Resin cements generally exhibit the highest compressive strengths.==

Retention¹⁴

• Lithium disilicate crowns cemented adhesively with resin cement had a higher failure load compared to GIC. Additionally, fewer cases of debonding.

Effect of Different Luting Agents on the Retention of Lithium Disilicate Ceramic Crowns

• Mixed literature regarding zirconia crowns
• Some suggest MDP containing cements promoted better bond strength
• Some found no differences
• We will review zirconia bonding towards the end of this lecture

Note

==A textbook table comparing cements to zinc phosphate (as the standard) shows that adhesive resin cements generally provide a greater percentage of retention.==

Types of Dental Cements¹⁵¹⁶

Zinc Oxide Eugenol

• Basic composition:
  • Zinc oxide + Eugenol + Rosin + Zinc Acetate
• Low strength + high solubility in oral environment
• A potential “sedative” effect for the pulp and otherwise biocompatible
  • Reinforced versions exist but are still mechanically inferior to permanent cements.
• Issues with eugenol inhibiting resin polymerization
• Temporary cement

Warning

Eugenol can inhibit the polymerization of resin cements, so eugenol-free alternatives are recommended if a resin cement will be used for the final restoration.

Zinc Phosphate¹⁷

• Basic composition:
  • Zinc oxide + magnesium oxide + phosphoric acid + water + buffers
• Popular cement for use in traditional cast restorations, (has been around since 1800s)
• Acceptable film thickness of 25um
• Ease of removal of the excess material after setting
• Potential issues with biocompatibility due to the inclusion of phosphoric acid (pH 2 at time of cementing). However generally well tolerated if preparation is not too close to the pulp
• • Acceptable working time of about 5 minutes

Info

The low initial pH (~2.0) is the primary cause of potential pulpal irritation.

Zinc Polycarboxylate¹⁸

• Basic composition
  • Zinc oxide + polyacrylic acid
• Attempts to address some biocompatibility issues from zinc phosphate by changing to polyacrylic acid

Improved Biocompatibility

The large polyacrylic acid molecules are less likely to penetrate dentin tubules and irritate the pulp.

• Also exhibits some adhesion to the tooth surface through chelation of calcium (but not to cast metal surfaces)
• Potentially technique sensitive due to mixing of viscous powder and liquid (mitigated via capsules)
• Additionally very short working time of under 3 minutes
• Indicated for high retention preps, or close to pulp horns

Glass ionomer cement (GIC)¹⁹

• Basic composition
  • Polycarboxylate + fluoraluminosilicate glass + water + tartaric acid
• Good biocompatibility + theoretically anticariogenic
• Aesthetic due to translucency of the cement
• **Potential for water absorption during early setting which would lead to erosion of the weakened material

Tip

A protective coating is sometimes advised to protect GIC cement during the early setting phase.

**

• Ionic bonding to tooth structure
• Concerns regarding possible post-op sensitivity not supported by literature when manufacturer followed

Resin modified glass ionomer²⁰

• Basic composition
  • GIC + resin
• Due to the inclusion of resin and corresponding photoactivators, some of the issues of GIC cement were improved
• Resin matrix improves the mechanical properties such as compressive and fracture strength compared to unmodified GIC
• Also suggest improvement in retention and bond strength
• Could be harder to remove excess. (Remember to tack cure)
• Some studies say it is contraindicated for all ceramic crowns (risk of fracture after water absorption)

Contraindication Update

While some literature contraindicates its use for all-ceramic crowns due to hygroscopic expansion, modern RMGI materials are often indicated by manufacturers for use with zirconia and lithium disilicate, suggesting this issue may have been addressed.

Resin based cements²¹

• Basic composition
  • Resin + filler (lower filler ratio for lower film thickness)
• Similar to restorative composite (exactly the same steps required)

Note

The lower filler ratio is similar to that of a flowable composite.

• Offers micromechanical retention
• Very high compressive strength
• Least soluble
• Technique sensitive (moisture control)
• May be more expensive
• Self cure, dual cure or light cure options

Info

Dual-cure is common, ensuring a full set even in areas the curing light cannot reach.

• Removal of excess may be difficult if not removed at tack cure stage

Special mention: Panavia²²

• Resin cement with bifunctional monomer, 10-methacryloyloxydecylhydrogen-phosphate (MDP)
• 10-MDP is able to interact with metal oxides via the hydrophilic phosphoric acid end group
• 10-MDP also facilitate a chemical bond with dentin through the formation of MDP-Ca insoluble salts

Mechanism of 10-MDP

==1. The hydrophilic phosphoric acid group chemically bonds to metal oxides (like zirconium oxide in zirconia) and to calcium in the tooth’s hydroxyapatite. 2. The hydrophobic methacrylate group co-polymerizes with and bonds to the resin matrix of the cement. This creates a durable chemical bridge linking the tooth, the cement, and the restoration.==

**Summary table of what cement to use based on crown type **²³

Restoration	Indication	Contraindication
Cast crown, metal-ceramic crown, partial FDP	1, 2, 3, 4, 5, 6, 7	—
Crown or partial FDP with poor retention	1, 2	3, 4, 5, 6, 7
Casting on patient with history of post-treatment sensitivity	1, 2, 3, 4, 5, 6, 7	Consider 4 or 7
Pressed, high-leucite, ceramic crown	1, 2	3, 4, 5, 6, 7
Slip-cast alumina crown	1, 2, 3, 4, 6, 7	5
Ceramic inlay	1, 2	3, 4, 5, 6, 7
Ceramic veneer	1, 2	3, 4, 5, 6, 7
Resin-retained partial FDP	1, 2	3, 4, 5, 6, 7
Cast post-and-core	1, 2, 3, 5, 6	4, 7
Key: Luting Agent Types
1. Adhesive resin: Adhesive, low solubility (Chief Advantages) | Film thickness, history of use (Chief Concerns) | Moisture control (Precautions)
2. Self-etch adhesive resin: Low solubility, ease of use, bonding to dentin (Chief Advantages) | Film thickness (Chief Concerns) | Moisture control (Precautions)
3. Glass ionomer: Translucency (Chief Advantages) | Solubility, leakage (Chief Concerns) | Avoid early moisture exposure (Precautions)
4. Reinforced ZOE: Biocompatible (Chief Advantages) | Low strength (Chief Concerns) | Only for very retentive restorations (Precautions)
5. Resin ionomer: Low solubility, low microleakage (Chief Advantages) | Water sorption, history of use (Chief Concerns) | Avoid with ceramic restorations (Precautions)
6. Zinc phosphate: History of use (Chief Advantages) | Solubility, leakage (Chief Concerns) | Use for “traditional” cast restorations (Precautions)
7. Zinc polycarboxylate: Biocompatible (Chief Advantages) | Low strength, solubility (Chief Concerns) | Do not reduce powder-to-liquid ratio (Precautions)

Clinical Application: Cementing Permanent Crowns²⁴

• After ensuring permanent crown seats fully (covered in other lecture, and consent from patient to cement.

Info

==The primary decision points for cement selection are whether the crown is zirconia, lithium disilicate (glassy ceramic), or metal.==

• metal and lithium disilicate cannot be etched so cementing indications will be the same

Glassy ceramic crowns (Lithium disilicate, etc.)²⁵²⁶²⁷

• Lab steps:
  • Prior to returning the crown, the lab may have already etched the internal fitting surface with hydrofluoric acid (eg ceram etch 9% hydrofluoric gel)
  • Silane coupling agent eg 3-methacryloxypropyltri-methoxysilane (MPS) forms bridge between the organic compounds in resin cements and inorganic ceramic molecules, hence improving the bond strength. Also increase surface energy and contact angle decreased for better resin/adhesive contact.

Silane Function and Application

• ==Function: Silane acts as a chemical bridge. One end bonds to the inorganic silica on the ceramic surface, while the other (organofunctional) end bonds to the organic resin matrix of the cement.==
• ==Application: The silane is applied, agitated for ~20 seconds to allow for chemical reaction, and then thoroughly air-dried to evaporate solvents.==

Lithium disilicate and silane study

Influence of the Multiple Layers Application and the Heating of Silane on the Bond Strength between Lithium Disilicate Ceramics and Resinous Cement

Zirconia crowns²⁸

• Lab steps:
  • Not able to be etched
  • Micromechanical surface treatments
    • Airborne particle abrasion to increase surface roughness (Pressure ~1 bar)

Warning

Care must be taken to avoid excessive pressure, which can create microcracks and weaken the zirconia.

• Chemical surface treatments
  • Hot acid treatment (eg sulfuric acid and hydrogen peroxide)
    • to try and etch the zirconia but has mixed results
  • Silica coating (aluminum oxide particle coated with silica)
    • works similar to particle abrasion, just to add some ssurface rougness

Cleaning and Surface Contamination²⁹

Note

After try-in, the internal surface of the crown is contaminated with saliva, blood, or try-in paste. This contamination lowers the surface energy and prevents the cement from properly wetting and bonding to the surface.

Glassy ceramics

• After try in completed
• Fitting surface cleanser: Katana or Ivoclean
• Otherwise can use phosphoric acid to remove saliva contaminants

Phosphoric Acid Use

While phosphoric acid can clean the surface, the literature is mixed. Some studies suggest it can weaken the final bond strength, possibly by over-etching the delicate surface. Universal cleaners (e.g., Ivoclean) are generally the more predictable option.

Protocol for Removal of Clinically Relevant Contaminants from Glass Ceramic-based Restorations

• 35% phosphoric acid and ivoclean/ other surface cleansers were effective

What about zirconia?³⁰

Cleaning Zirconia Surface Prior To Bonding: A Comparative Study of Different Methods and Solutions Taiseer A. Sulaiman, DDS, PhD¹; Ali Altak, DDS,¹ Awab Abdulmajeed, DDS, MS²; Brandon Rodgers, BS,¹ & Nathaniel Lawson, DMD, PhD³

Conclusion: Air-borne particle abrasion: best outcome to restore previous uncontaminated surface bond strengths. Followed by HF acid or intaglio cleaners.

Clinical Recommendation

==Using a universal cleaning paste like Ivoclean or Katana Cleaner is a practical and effective method for chairside decontamination of zirconia.==

Clinical Protocols for Specific Cement Systems³¹

Variolink® Esthetic LC

Phase 1: Try-In and Assessment

1. Try-In:
   • Apply the Variolink Esthetic Try-In paste to the restoration. This is a temporary gel, not the permanent cement.
   • Seat the restoration and assess the color and fit. Confirm that you and the patient are happy with the shade.
2. Cleaning and Isolation:
   • Remove the restoration. Clean the try-in paste from the restoration and the tooth surface.
   • Isolate the tooth, for example, with a rubber dam.

Phase 2: Restoration Pre-treatment (Extra-oral)

The transcript recommends completing this phase before preparing the tooth to prevent contamination of the etched and bonded tooth surface.

1. Clean Restoration:
   • Thoroughly wash the internal fitting surface of the restoration with water to remove as much try-in gel as possible.
   • Air dry the restoration.
   • (Optional, per transcript): Use a surface cleanser (like Ivoclean) to remove any contaminants like saliva or blood, rub it on, wash it off, and dry the surface again.
2. Condition the Surface:
   • For Ceramic: Etch the restoration according to the manufacturer’s instructions. For example, etch IPS e.max for 20 seconds or IPS Empress for 60 seconds using hydrofluoric acid (IPS Ceramic etching gel).
   • For Composite: Roughen the surface according to instructions, for example, by sandblasting (2 bar, $A{l}_2{O}_3$, 100 $\mu$m) or using finishing diamonds.
3. Silanate:
   • Apply Monobond Plus to the conditioned internal surface.
   • Agitate it and allow it to react for 60 seconds.
   • Disperse the silane with a strong stream of air. Do not rinse off Monobond Plus, as it is purely a silanating agent.

Phase 3: Tooth Preparation (Intra-oral)

This process is similar to preparing for a direct composite.

1. Clean and Etch:
   • Rinse the prepared tooth with water and air dry.
   • Apply phosphoric acid (Total Etch). The PDF indicates this is optional and to leave it for 15-30 seconds. (The transcript notes total or selective etch protocols are both options).
   • Rinse the etchant off thoroughly with water and air dry the tooth.
2. Apply Adhesive:
   • Apply Adhese Universal to the tooth surface. This adhesive is recommended for use with Variolink.
   • Scrub the adhesive into the surface for 20 seconds.
   • Use air to thin the adhesive layer, being careful to “Avoid pooling”.
   • Light cure the adhesive layer for 10 seconds using a curing light such as the Bluephase G4.

Phase 4: Cementation and Curing

1. Apply Cement and Seat:
   • Apply the permanent cement (Variolink Esthetic LC or Dual Cure) to the pre-treated internal surface of the restoration. Do not apply too much.
   • Fully seat the restoration onto the prepared tooth. (The transcript suggests having the patient bite on a cotton roll to help seat the crown completely).
2. Tack Cure and Excess Removal:
   • Tack Cure: Perform a brief “tack cure” for 2 seconds (or 1 second per surface, per the transcript) using the curing light. This partially sets the cement to a gel-like state, making excess easier to clean.
   • Remove Excess:
     • Use a plastic instrument to scrape off the excess cement from the buccal and lingual/palatal surfaces.
     • For interproximal areas, have an assistant hold the crown down. Pass floss through the contact point, then pull the floss out to the side (buccally or lingually). Do not pull the floss back up occlusally, as this could dislodge the crown.
3. Final Cure:
   • Apply Liquid Strip (a glycerin gel) around all the margins. This prevents the sticky oxygen inhibition layer from forming on the surface of the resin cement.
   • Perform the final cure by light-curing through the Liquid Strip. Cure each surface/segment for 10 seconds.

Phase 5: Finishing

1. Polish: Rinse off the Liquid Strip and polish the margins.
2. Fluoride: Apply Fluor Protector S.
3. Final Check: The transcript recommends taking a final bitewing radiograph to check for any residual cement in the interproximal areas, which must be removed.

PANAVIA™ F 2.0 for Zirconia³²³³³⁴

Cementation of ceramic oxide restorations: PROCERA™, IN-CERAM™, CERCON™ and other zirconia prostheses.

1. Mix equal amounts of ED PRIMER II A&B and apply to the tooth. Then, wait 30 sec. ED PRIMER II initiates set of cement.
2. Gently air dry.
3. Dispense equal amounts of paste A&B.
4. Mix paste A&B for 20 sec.
5. Apply the mixture of the paste to the sandblasted crown.

Tip

==Apply the mixed cement inside the crown, not on the tooth.==

6. Remove excess cement. (For easy clean up, partially light-cure the excess cement for 2-3 sec. with conventional halogen or LED light, then remove the excess.)
7. Cure the margins:
   • Light cure: 20 sec. per surface (Conventional halogen or LED light) OR 5 sec. per surface (Plasma arc or fast halogen light)
   • OR
   • Self cure: Apply OXYGUARD II to the margins. Then, wait 3 min.

PANAVIA™ F 2.0 for Metal crowns/PFM crowns³⁵³⁶

Cementation of precious & semi-precious metal crowns, PFM crowns, bridges, inlays and onlays.

Protocol Summary of Panavia for Metal/PFM

==The protocol is identical to the zirconia protocol, with one key difference in restoration preparation:

• Restoration Preparation: After the lab has sandblasted the metal surface, apply Alloy Primer to the intaglio surface of the crown instead of a zirconia-specific primer. The tooth preparation and cementation steps remain the same.==

Cementation of precious & semi-precious metal crowns, PFM crowns, bridges, inlays and onlays.

1. Sandblast, wash & dry.
2. Apply ALLOY PRIMER to internal surface of precious metal restoration.
3. Mix equal amounts of ED PRIMER II A&B. Apply to the tooth. Then, wait 30 sec. ED PRIMER II initiates set of cement.
4. Gently air dry.
5. Dispense equal amounts of paste A&B.
6. Mix paste A&B for 20 sec.
7. Apply mixture of the paste.
8. Remove excess cement. (For easy clean up, partially light-cure the excess cement for 2-3 sec. with conventional halogen or LED light, then remove the excess.)
9. Cure the margins:
   • Light cure: 20sec. per surface (Conventional halogen or LED light) OR 5sec. per surface (Plasma arc or fast halogen light)
   • OR
   • Self cure: Apply OXYGUARD II to the margins. Then, wait 3 min.

Guidelines³⁷

Manufacturer Recommendations (Ivoclar Example)

• ==Lithium Disilicate (e.max): Clean with Ivoclean, apply Monobond Plus (silane), and cement with Variolink Esthetic.==
• ==Zirconia: Clean with Ivoclean, (no silane needed), and cement with a self-adhesive or MDP-containing cement (e.g., Panavia, SpeedCEM).==

Step	Lithium Disilicate (LiSi2​) (IPS e.max CAD / IPS e.max Press)	Zirconium Oxide (ZrO2​) (IPS e.max ZirCAD)
Initial Preparation	Etching	Cleaning with $A{l}_2{O}_3$ at max 1 bar (15 psi)
Etching Product	Monobond Etch & Prime OR IPS Ceramic Etching Gel	—
Try-in	Variolink Esthetic or Multilink Automix Try-In / Liquid Strip	Variolink Esthetic or Multilink Automix Try-In / Liquid Strip
Cleaning after Try-in	Ivoclean	Ivoclean
Conditioning	Monobond Plus	—
Cementation Type	Adhesive	Self-adhesive / Conventional
Cementation Product	Variolink Esthetic / Multilink Automix	Panavia / Vivaglass CEM

Rely X Unicem 2 Automix³⁸³⁹

• Another cement available in clinic

• Two types of tips

  • use the thick tip for cementing crowns the thing one is for getting to a post space

• Marketed as a “dual curing, self-adhesive resin cement for indirect restorations”

• Resin cement (like Variolink aesthetic), but it is self adhesive and does not require etching and bonding.

  • Think of it like “self-etch adhesives” vs “two step etch and rinse adhesives”
  • Achieves demineralization via acidic monomers (carboxylic acid or phosphoric acid functional groups).
  • Methacrylated phosphoric esters

• However due to limited demineralization and infiltration, may not have good bond strength to enamel.

Warning

The demineralization is less aggressive than with phosphoric acid. The bond to enamel may be less effective than with etch-and-rinse systems. A selective enamel etch may be beneficial to improve bond strength.

• Dual cure with a setting time of about 6 minutes

Instructions for use of rely-x:⁴⁰

• Clean tooth, rinse and slightly dry with 2-3 bursts of air, but DO NOT OVERDRY.
• After appropriate cleaning and pretreatment of the fitting surface, dispense into the crown with the “standard tip”.
• Continue with steps for clean up as per regular resin cements

Note

Seat the crown, tack cure, remove all excess cement, and perform the final cure. The cleanup process is the same as for other resin cements.

Self adhesives cements⁴¹⁴²

• Benefits:
  • Simplified clinical procedure
  • Cementation of root canal glass fibre posts (due to shape of root canal and C factor, lower polymerization shrinkage may be beneficial)
• Disadvantages
  • Long term bond strength may be lower than that of conventional resin cements (Mixed results)

summary table of cements in this lecture

Step	Lithium Disilicate (LiSi2​) (IPS e.max CAD / IPS e.max Press)	Zirconium Oxide (ZrO2​) (IPS e.max ZirCAD)
Initial Preparation	Etching	Cleaning with $A{l}_2{O}_3$ at max 1 bar (15 psi)
Etching Product	Monobond Etch & Prime OR IPS Ceramic Etching Gel	—
Try-in	Variolink Esthetic or Multilink Automix Try-In / Liquid Strip	Variolink Esthetic or Multilink Automix Try-In / Liquid Strip
Cleaning after Try-in	Ivoclean	Ivoclean
Conditioning	Monobond Plus	—
Cementation Type	Adhesive	Self-adhesive / Conventional
Cementation Product	Variolink Esthetic / Multilink Automix	Speedcem Plus / Vivaglass CEM

Footnotes

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